Diagnostic Radiology: Radiography Flashcards

1
Q

Mammography

A
  • Low dose X-ray
  • High contrast
  • High resolution
  1. Screening
    - asymptomatic patient
    - early detection of small breast cancers e.g. DCIS
  2. Diagnostic
    - symptomatic patient
    - USG / clinical exam detected breast mass

2 views:

  • Medial lateral oblique view: can see pectoralis muscle
  • Craniocaudal view
  • Compressed view
  • Magnified view: further characterise lesion e.g. microcalcification

Sensitivity decrease in dense breast —> less sensitive in young patients

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2
Q

Intravenous urogram (IVU)

A

Demonstrate urinary tract for suspected urinary tract pathology

Use IV non-ionic contrast which are excreted in kidney to contrast urinary system

Common indications:

  • Haematuria
  • Loin pain

Preparation:

  • Laxative (decrease faecal matter)
  • Fast for 4 hours
  • Hydration —> distend urinary collecting system
  • Vascular access
  • Compression band —> distend pelvocalyceal system for evaluation
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3
Q

Fluoroscopy

A
  • Dynamic movie
  • also use X-ray

Use:

  1. GI
  2. Biliary system
  3. Genitourinary system
  4. Interventional procedures

Contrast medium:

  1. Barium
  2. Water-soluble contrast medium
  3. Air (by effervescent granules)
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4
Q

GI tract fluoroscopy

A

Barium swallow: Hypopharynx, Esophagus

Barium meal: Stomach, Duodenum

  • dyspepsia
  • epigastric pain
  • weight loss
  • suspected stomach cancer
  • suspected perforation of peptic ulcer

Barium follow-through: Small bowel

  • delayed film for small bowel evaluation
  • nasal catheter inserted at duodenal-jejunum junction, give contrast —> double contrast (barium, methylcellulose) —> better distension, patient discomfort

Barium enema: Large bowel

  • contrast reach caecum 4-6 hours
  • change in bowel habit
  • pain
  • mass
  • blood in stool
  • bowel obstruction
  • air inflation through rectum —> double contrast
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5
Q

Patient preparation for barium study

A
  1. Fasting
  2. Bowel preparation
    - enema
    - low residual diet x 3 days
    - klean prep
  3. IV Buscopan
    - decrease bowel peristalsis
    - better distension
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6
Q

Barium complications

A
  1. Perforation
    - peritoneal adhesions
    - granulomata
    —> Barium peritonitis
  2. Aspiration
    - relatively harmless
    - physiotherapy
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7
Q

Biliary tract fluoroscopy

A

Cholangiogram:

  • Percutaneous cholangiogram
  • T-tube cholangiogram

Indications:

  1. Assess biliary status —> obstruction e.g. stone, tumour, extrinsic compression
  2. Assess post-op status —> any leakage

Contraindications:
- Biliary sepsis

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8
Q

Interventional procedures

A
  1. Central line insertion
  2. Percutaneous transhepatic biliary drainage (PTBD) —> relieve obstruction
  3. Angiography
    - assessment of arterial / venous disease
    - localisation of site of haemorrhage +/- embolisation
    - intravascular injection of contrast
    - preparation: Fasting + IV access + Clotting profile / platelet
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9
Q

Adverse reactions of Intravascular contrast medium (water-soluble)

A

Mild:

  • sneezing
  • nausea

Moderate:

  • pruritis
  • flush
  • fever / chills
  • increased / decreased BP

Severe:

  • difficulty in breathing
  • periorbital edema
  • cardiac arrhythmia
  • pulmonary edema
  • death
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10
Q

Risk of radiological examination

A
  1. Risk from radiation
  2. Risk from contrast medium
  3. Risk due to technique
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11
Q

Radiation

A
  • No known safe radiation dose
  • Spontaneous genetic mutations and malignant diseases
  • Reduce unnecessary examination
  • Use alternative e.g. USG, MRI
  • Shielding of organs
  • Filtration of x-ray beam
  • Control of irradiation + Recording of irradiation time
  • Thermoluminescent dosimeter + Lead apron to protect staff
  • Quality assurance
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