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Radiology > CT Imaging of the Thorax > Flashcards

CT Imaging of the Thorax Flashcards

1
Q

Where is this done at:
patient is sent out for imaging (CT) at an imaging center or hospital; radiologist does complete interpretation of images, and you receive report

A

primary care outpatient setting

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2
Q

Where is this done at:
Some have CTs, some don’t; you may review and interpret x-rays and can ask for a quick read by radiologist or wait for results; radiologist has final “read” responsibility and will send report

A

Urgent care

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3
Q

Where is this done at:
patient is taken from bed to imaging department nearby; provider may review images and will often consult with the radiologist by phone for urgent image results; radiologist has final “read” responsibility

A

emergency department

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4
Q

Where is this done at:
- ordering imaging prior to surgery; they will often review imaging as well as radiologist; radiologist has final “read” responsibility, but surgeon is heavily involved and may act on their own interpretation

A

surgery

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5
Q

What settings can imaging interpretation be done?

A
  • primary care outpatient setting
  • urgent care
  • emergency department
  • surgery
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6
Q

What is the #1 reason for a chest CT?

A

follow-up on an abnormal chest radiograph result

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7
Q

What are indications for a chest CT?

A
  • abnormal chest x-ray results
  • lung or thorax cancer
  • evaluate for acute pulmonary infection or acute process
  • evaluate from cardiac or vascular disease
  • trauma
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8
Q

How are chest CTs used for lung/thorax cancer?

A
  • annual screening or lung cancer
  • presence of pulmonary nodules
  • further evaluation of a suspicious mass on CXR
  • identification of metastasis from another primary cancer
  • cancer staging
  • tumors in mediastinum (lymphomas/thymomas)
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9
Q

What are these associated with:
- pneumonia that hasn’t resolves or is atypical in appearance
- empyema of lungs
- pulmonary embolism
- ARDS (acute respiratory distress syndrome)
- pneumothorax or hemothorax

A

chest CT to evaluate for acute pulmonary infection or acute process

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10
Q

What are these associated with:
- COPD
- interstitial lung disease

A

chest CT to evaluate for chronic pulmonary disease

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11
Q

What are these associated with:
- thoracic aortic aneurysm or dissection
- congenital cardiac disease
- coronary artery occlusion
- strain or hypertrophy of ventricles
- pericardial disease

A

chest CT to evaluate for cardiac or vascular disease

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12
Q

What are these associated with:
- rib fractures and flail chest
- major contusions chest wall
- general scan after major trauma (pan scan)

A

chest CT for trauma

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13
Q

What is performed to further investigate inconclusive or abnormal CXR findings?

A

chest CT

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14
Q

What are some advantages of a CT?

A
  • rapid scanning time (5-10 mins)
  • useful in emergent situations
  • provides large amount of information to help narrow differential diagnosis
  • available and ubiquitous
  • less claustrophobia than MRI
  • no need for sedatives for claustrophobic patients
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15
Q

What are some disadvantages of a CT?

A
  • significant radiation exposure
  • exposure to contrast agents and potential (small) for nephrotoxicity or adverse renal events
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16
Q

What consists of hundreds of xrays that are stitched together by a computer program?

A

CT scans

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17
Q

What is this describing:
gantry moves patient into position, stops and image taken. This is repeated for all sequences and scan can take 5-10 minutes?

A

traditional CT

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18
Q

What is this describing:
in this type of CT, the gantry moves continuously to put the patient into the correct position for each image. Scan can be under a minute

A

helical CT

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19
Q

What is this describing:
uses helical technology, but now has up to 256 detectors to create quick and detailed images

A

multidetector CT

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20
Q

What are some CT scan advantages over x-rays?

A
  • avoids superimposition of structures found on xrays
  • able to provide detailed imaging of specific areas
  • more accurate diagnosis over x-ray
  • large amount of detail rapidly which allows for quick diagnosis in ED
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21
Q

What are the different views/positioning of CT scans and can be switched by use of your computer?

A
  • coronal view
  • sagittal view
  • axial view
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22
Q

When we view CT images, we interpret them as if what?

A

as if we are standing at the patient’s feet and looking up at the “slices” made by the CT

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23
Q

What describes the radiodensity of material?

A

attentuation

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24
Q

As x-ray passes through denser objects like bone or metal, the signal is (1)

A

highly attenuated

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25
Q

In CT scans, bone and metal appear?

A

highly attenuated (white)

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26
Q

In CT scans, soft tissue and fat appears?

A

grey

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27
Q

In CT scans, air appears?

A

low attenuation (dark grey to black)

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28
Q

The density of structures on CT is measured in (1)

A

Hounsfield units

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29
Q

Blood is (1) than water, so it will appear (2)

A
  1. more dense
  2. whiter
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30
Q

What may have higher density than the tissue around it?

A

a tumor

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31
Q

What is used to improve their interpretation, and radiologists can “zoom in” within different ranges of the hounsfield scale?

A

windowing

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32
Q

What are the different types of windows on the CT thorax?

A
  • soft tissue window (organs, anything soft)
  • bone window
  • lung window (pneumonia)
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33
Q

What is used to better visualize for soft tissue structures of the thorax (fat, muscles, organs)?

A

soft tissue window

34
Q

What does not visualize the lung parenchyma as it is out of the Hounsfield range of the window?

A

soft tissue window

35
Q

What gives you the ability to view the lung parenchyma for visualization of:
- pneumonia
- nodules or masses
- COPD
- occupational lung disease
- interstitial lung disease

A

lung window

36
Q

What gives you the ability to view:
- clavicle
- sternum
- vertebral bodies
- ribs

A

bone window

37
Q

What allows you to evaluate for:
- fracture or trauma
- bony malignancy or metastasis
- degenerative disk disease

A

bone window

38
Q

What does this describe:
- increased density
- higher Hounsfield units

A

hyperdense

39
Q

What does this describe:
- less dense
- lower Hounsfield units

A

hypodense

40
Q

What does this describe:
- same density when compared to other tissue

A

isodense

41
Q

What can be added to the images to better delineate specific structures and can have systemic reactions from any administration, but anaphylaxis-type reactions almost always with IV administration?

A

contrast

42
Q

What are the different types of contrast used in CT?

A
  • intravenous iodine based
  • oral/rectal barium-based
43
Q

What is used to evaluate for intravascular and organ disease?

A

intravenous iodine based contrast

44
Q

What is better when evaluating digestive or GI conditions, can be used to identify colon or rectal tumors on CT abdomen and pelvis, and is not used in chest imaging?

A

oral/rectal barium-based contrast

45
Q

What are some other routes of IV iodinated contrast that are less common?

A
  • intrathecal
  • intraarterial
  • intraabdominal
46
Q

Some people have different reactions when given what?

A

contrast

47
Q

What is the most severe and possibly fatal adverse outcome with IV iodinated contrast?

A
  • anaphylactoid reactions
48
Q

(1) do not require previous exposure while (2) do require previous exposure to occur

A
  1. anaphylactoid reactions
  2. anaphylactic reactions
49
Q

What causes possible increase in serotonin, histamine, and complement cascade? (can make you itch)

A

contrast

50
Q

People with allergic-like reactions to contrast can be what?

A

premedicated with oral steroid and antihistamine

51
Q

What results from properties of the contrast material that can cause ionic or fluid disruptions to body homeostasis and is usually brief and transient?

A

nonanaphylactoid reactions

52
Q

What are some nonanaphylactoid reactions?

A
  • feeling of flushing or warmth
  • metallic taste in mouth
  • nausea or vomiting
  • bradycardia
  • vasovagal lightheadedness
  • neuropathy
53
Q

What are some indicationns to order a CT of thorax with contrast?

A
  • don’t need to focus on the circulatory system
  • focus is on lung parenchyma
54
Q

Annual CTs are used for?

A

preventative screening for lung cancer

55
Q

In a CT with and without IV contrast, patient may be scanned (1) contrast first and then contrast is (2) and a second scan is performed

A
  1. without
  2. added
56
Q

If you order a CT with and without contrast, the images are what?

A

timed to be taken when contrast reaches specific structures (capillary beds for most exams, pulmonary arteries for possible pulmonary embolism)

57
Q

What are some indications for ordering a CT of the thorax with and without IV contrast?

A
  • suspicion of lung cancer
  • infection of the skin and soft tissue
58
Q

What is non-standard and is when images are times to coincide with the contrast material passing through the pulmonary arterial system?

A

CT pulmonary angiogram (CT-PA)

59
Q

What are indications for a CT-PA?

A

suspicion for a pulmonary embolism

60
Q

What is non-standard and is when images are timed to coincide with the contrast material passing through specific parts of arterial system?

A
  • CT angiography
61
Q

What are some indications for a CT angiography?

A
  • aneurysms
  • artherosclerosis
  • evaluate arteries supplying a tumor
  • stenosis of blood vessels
62
Q

What are the different contrast phases?

A
  • arterial phase
  • venous phase
  • delayed phase
63
Q

What contrast phase is 15-45 seconds after IV contrast?

A

arterial phase

64
Q

What contrast phase is 60 seconds after IV contrast?

A

venous phase

65
Q

What contrast phase can be up to 10 minutes after injection?

A

delayed

66
Q

Everyday, we are exposed to radiation as measures in (1)

A
  1. millisierverts (mSv)
67
Q

You have an increased risk of cancer with what (radiation)?

A
  • prolonged exposure to 10 mSv
  • brief exposure to 50 mSv
68
Q

Who have a higher likelihood of later cancer vs. non exposed children? What cancers?

A

children exposed to CT scan
- leukemia
- brain cancer

69
Q

One CT scan of the abdomen and pelvis without contrast is equivalent to (1) chest xrays and (2) mammograms

A
  1. 220
  2. 37
70
Q

What do principles of ALARA in radiology mean?

A

as low as reasonably achievable (in radiology)

71
Q

Which settings have the highest risk of radiation?

A
  • ED
  • surgery
  • primary care
72
Q

What is the upper limit of normal size for the ascending aorta?

A

4 cm

73
Q

What is the upper limit of normal size for the descending aorta?

A

3 cm

74
Q

Evaluation of the aorta on CT scans is looking for what?

A
  • plaques on walls
  • aneurysm or dissection
  • thrombus
75
Q

What decrease in size as they get closer to bifurcating at the T5 level?

A

pulmonary arteries

76
Q

Why do you evaluate the appearance of pulmonary arteries on a CT?

A
  • filling defects with PE
  • aneurysms of pulmonary arteries
77
Q

What is the mediastinum generally evaluated for in CT scans?

A

masses
- lymphoma
- thymoma
- teratoma
- thyroid masses

78
Q

What is thin-walled and appears ovoid during inspiration and partially flattens with exhalation?

A

trachea

79
Q

What is thin-walled and can be hard to see as they move toward the periphery?

A

bronchi and bronchioles

80
Q

What are the steps in evaluation of a CT scan?

A

step 1: right pt, right scan, right date
step 2: review pts history and physical
step 3: review all windows on CT using systematic approach

Radiology (6 decks)

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