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PHTY205 > Diagnostic Imaging > Flashcards

Diagnostic Imaging Flashcards

1
Q

what are the main types of diagnostic imaging?

A
  • CXR &CT
  • MRI
  • Ultrasound
  • nuclear medicine imaging
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2
Q

CXR & CT
what do solid tissues appear as on imaging?

A

white (absorb radiation)

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3
Q

CXR & CT
what appears as dark?

A

air filled spaces which dont absorb radiation

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4
Q

what does an MRI use?

A

magnets and radiofrequency pulses

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5
Q

what does an US use?

A

high frequency sound waves, reflected from tissues

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6
Q

what happens in nuclear medicine imaging?

A

radioactive medication is injected, inhaled or swallowed, then picked up with a gamma camera

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7
Q

is a chest x-ray non-invasive?

A

yes

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8
Q

is a chest xray common?

A

yes

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9
Q

is a CXR low or high radiation?

A

low (vs CT)

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10
Q

what is a CXR used for?

A
  • diagnosis of conditions
  • pre-operative assessment
  • to check correct position of medical therapies involving lines/tubes (e.g. IV, ICC)
  • to assess effectiveness of therapies
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11
Q

limitations of a CXR

A
  • 2D view of a complex 3D structure
  • therefore, requires multiple CXR views to visualise structures adequately
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12
Q

how is the CXR always viewed?

A

as if the patient is facing you (i.e. their left is your right)

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13
Q

what happens if the patient has the left chest wall on the cassette?

A
  • diminishes effect of heart magnification
  • demonstrates better anatomical detail of the heart
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14
Q

when is an AP CXR taken?

A

when the patient is unable to stand/ go to the radiology department
- may be taken sitting / supine

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15
Q

order of how to read a CXR?

A
  1. technical details e.g. name, AP/PA
  2. quality of film
  3. extra-thoracic structures e.g. UL girdle, soft tissues, abdominal structures
  4. thoracic cage e.g. bones, diaphragm
  5. intra-thoracic structures e.g. mediastinum (trachea, heart, hilum), lung fields
  6. attachments / foreign structures
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16
Q

IMAGE QUALITY
What should the medial ends of the clavicle be for you to know the patient isnt rotated?

A

equidistant from the spinous processes

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17
Q

IMAGE QUALITY
what should the film be taken on?

A

full inspiration

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18
Q

what ribs intersect the diaphragm (anteriorly)

A

5-6 (one rib lower on the left)

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19
Q

what ribs intersect the mid diaphragm posteriorly?

A

9-10 (one rib lower on the left)

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20
Q

how can you tell if CXR = over or under exposed?

A

IV disc should be just visible through heart shadow

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21
Q

underexposed CXR characteristics?

A
  • whiter
  • unable to see IV disc spaces behind heart
  • may ‘over-interpret’ opacities
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22
Q

overexposed CXR chracteristics?

A
  • blacker
  • loss of lung markings
  • may ‘miss’ abnormalities
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23
Q

what UL girdle things can you see on CXR?

A
  • clavicle height
  • scapular outlines (white arrows, on AP view)
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24
Q

what soft tissues can you see on CXR?

A
  • muscles / adipose tissue
  • breast shadow
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25
Q

what features lie below the diaphragm on a CXR?

A

air, gastric bubble

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26
Q

THORACIC CAGE
what features of the spine can you se on CXR?

A

curvatures e.g. scoliosis/ kyphosis, rotation, fractures

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27
Q

THORACIC CAGE
what rib features do you look for on CXR?

A
  • shape anteriorly & post
  • crowding / increased rib spaces
  • fractures
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28
Q

THORACIC CAGE
what do you look for in diaphragm

A
  • shapes, outline/ borders, position, angles
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29
Q

diaphragm features in CXR

A
  • should be clearly defined
  • domed shape
  • costophrenic & cardiophrenic angles (clear & acute)
  • right hemi diaphragm (2xm higher than left)
  • raised : paralysed (SCI/phrenic nerve), LL atelectasis/ collapse, low lung volumes / poor inspiratory effort
  • lowered: hyperinflation (gas trapped in lungs), gas in the pleural space (pneumothorax)
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30
Q

INTRA-THORACIC STRUCTURES (MEDIASTINUM)
Trachea features

A
  • midline
  • bifuractes into L&R main bronchi at the carina, approx T5-7 vertebral level
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31
Q

INTRA-THORACIC STRUCTURES (MEDIASTINUM)
Hilar region features

A
  • contains pulmonary arteries / veins, bronchi, lymph nodes
  • size
  • position (L should be higher than R)
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32
Q

INTRA-THORACIC STRUCTURES (MEDIASTINUM)
Major vessels features

A
  • aortic arch
  • vena cava
33
Q

INTRA-THORACIC STRUCTURES (MEDIASTINUM)
Heart features

A
  • position = 1/3 on right, 2/3 on left
  • size & shape = heart should be <50% internal diameter of the chest cavity (larger heart size may be cardiomegaly)
  • borders = clearly defined, loss of left heart border could mean issue in lingula, loss of right heart border could mean issue in RML
  • heart chambers = RA, RV, LA, LV
34
Q

how should the lung fields look?

A

mostly dark with thin white lung markings throughout

35
Q

where do the lung markings extend to?

A

edges near thoracic cage

36
Q

density of lung fields

A

L=R

37
Q

when is there extra shadowing/ opacity? which pathologies?

A
  • pneumonia/ consolidation (patchy opacity)
  • atelectasis / collapse
  • cancer / tumour (rounded opacity)
38
Q

how do CT’s work?

A

X-rays are processed by a computer to form tomographic (slices) images and a 3D picture

39
Q

what are the 3 main types of CT?

A
  1. standard method
  2. CTPA (CT pulmonary angiography)
  3. high res CT
40
Q

Standard Method Chest CT

A
  • contrast used to highlight mediastinal structures
  • entire thorax imaged
  • slices = 5-10 mm thick
41
Q

CTPA

A
  • looking for blood flow abnormalities, such as pulmonary embolus
  • use a contrast
42
Q

high res CT

A
  • very thin (1mm) axial sections
  • only 10-20 mm taken
  • no contrast used
  • used in ILD suspencted & bronchectasis (highlights narrow walls & thick mucous plugging)
43
Q

advantages of chest CT

A
  • 3D images
  • greater diagnostic accuracy and localisation of pathology
  • better at imaging small airways, mediastinum, pleura, and lung parenchyma than CXR
  • CTPA is gold standard for diagnosing PE
44
Q

disadvantages of chest CT

A
  • cost
  • access
  • radiation dose is much higher than XR
  • CT scan contrast agents can worsen vulnerable kidneys
  • minor movement artefact
45
Q

what is a silhouette sign?

A
  • the loss of a silhouette/ clear defined border
46
Q

how does a silhouette sign occur?

A

if an area of lung becomes collapsed/ consolidated it becomes denser (more white), as there is less air there

47
Q

what does the loss of the L heart border indicate issues with?

A

lingula

48
Q

what does the loss of the R heart border indicate issues with?

A

RML

49
Q

what does the loss of the diaphragm border indicate issues with?

A

lower lobe

50
Q

air bronchogram definition

A

air-filled bronchi (dark) are made visible by the opacification of the surrounding alveoli (white)

51
Q

air bronchogram pathophysiology

A

caused by pathologic alveolar process in which something other than air fills the alveoli e.g. pus, blood, fluid, ARDS, pulmonary oedema

52
Q

what is atelectasis/ lung-collapse a result of?

A

loss of air in a lung / part of the lung with subsequent volume loss & increased density

53
Q

features of atelectasis/ lung volume

A
  • opacity (due to loss of air)
  • smaller lung due to loss of air in the lung overall
  • structures can shift towards an area of lung collapse
    - e.g. diaphragm moves up, mediastinum moves towards the side of loss of volume, rib cage moves towards mediastinum
  • +/- silhouette sign depending which part of lung is affected
  • +/- air bronchogram
54
Q

what is consolidation?

A

alveoli filled with fluid, usually indicating pneumonia

55
Q

features of consolidation on CXR:

A

Opacity (whiteness)
* Lung is ‘solid’ because air spaces are filled with fluid
* Opacity may be “anatomically” delineated (lobar
pneumonia) or “patchy” (bronchopneumonia)
– No loss of volume
± silhouette sign depending which part of lung is affected
± air bronchogram

56
Q

consolidation vs collapse

A
  • collapse = structures are shifted towards the area of collapse
57
Q

hyperinflation

A

increased lung volumes e.g. TLC

58
Q

Features of hyperinflation on CXR

A

Increased lucency (blackness)
* Lung contains more air
* Loss of lung tissue (less lung markings)
Increased volume
* Low, flat diaphragm (loss of dome)
* Obtuse (less acute) costo and cardiophrenic angles
* Increased rib spaces
* Posterior ribs more horizontal
Elongated heart & media stinum structures
± bullae (thin walled air filled spaces within the lung)

59
Q

what are bullae

A

numerous thin-walled,
air-containing structures
that represent the walls
of numerous bullae
(white arrows).

60
Q

acute pulmonary oedema pathophysiology

A

fluid accumulation in the extra-vascular spaces of the lung (i.e. interstitium &/or alveoli)

61
Q

acute pulmonary oedema aetiology (causes)

A
  • cardiogenic (e.g. left heart failure)
  • non-cardiogenic (e.g. sepsis, drowning, ARDS)
62
Q

features of acute Pulmonary Oedema on CXR

A

Increased opacity (diffuse, bilateral, “batwing”)
± septal lines (Kerley B lines)
± cardiomegaly (where heart failure is the cause)
± pleural effusions

63
Q

Pleural effusion definition

A

fluid in the pleural space

64
Q

features of PEff on CXR

A

– Increased opacity
– Blunting of the costophrenic angle/s (meniscus)
– May be unilateral or bilateral depending on cause
– Characteristic ovoid/elliptical appearance on lateral view
± features of the causal condition (eg heart failure, Ca)

65
Q

Pneumothorax definition

A

air in the pleural space (between visceral and parietal pleura)

66
Q

Features of pneumothorax on CXR

A

– Area of increased lucency (blackness)
– Absence of lung markings
– Lung edge visible (of visceral pleura)
– Usually accumulates non-dependently; apical on upright
CXR if small pneumothorax
± other features (eg # ribs, subcutaneous emphysema)

67
Q

what is a tension pneumothorax?

A

progressive build-up of air within the pleural space

68
Q

what is a tension pneumothrax usually due to?

A

a lung laceration which allows air to escape into the pleural space but not to return

69
Q

is a tension Pneum life threatening? if so, why?

A

yes - requires urgent decompression

70
Q

what does a tension pneum result in?

A

shift of structures away
from side of pneumothorax (>1/3 of hemithoracic volume or shift of mediastinum)

71
Q

subcutaneous emphysema definiton?

A

air in the subcutaneous tissues (skin & muscle layers)

72
Q

features of subcutaneous emphysema on the CXR

A

areas on increased lucency (blackness) in extrathoracic soft tissue +/- other features (e.g. #ribs, pneumothorax)

73
Q

what is a lung abscess?

A

A localized collection of pus within the lung that leads to formation of a cavity, usually with a thick wall.

74
Q

what is a malignant mesothelioma?

A

an aggressive malignant tumour of the mesothelium, mostly arising from the pleura

75
Q

what is a malignant mesothelioma the most common of?

A

primary pleural neoplasm

76
Q

CXR mesothelioma

A

pleural opacity which encases & contracts the affected hemithorax
+/- pleural effusion

77
Q

key points to note with infants CXR

A
  • Different chest wall shape
  • Horizontal ribs
  • Proportionally larger heart
78
Q
A

PHTY205 (5 decks)

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