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MRT Year 2 > Fluoro Comp > Flashcards

Fluoro Comp Flashcards

1
Q

What does the liver do?

A

Manufacture bile

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2
Q

2 major lobes of the liver? What separates them?

A

-Right (larger)
-Left
Falciform ligament

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3
Q

2 minor lobes of the liver?

A

Located in the posterior right lobe

  • Quadrate: between gallbladder and falciform ligament (inferior)
  • Caudate: posterior to quadrate and IVC (superior)
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4
Q

Parts of the gallbladder?

A

Fundus, body, neck

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5
Q

What prevents the cystic duct from collapsing?

A

Membranous folds “spiral valve”

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6
Q

How does the gallbladder concentrate the bile?

A

Hydrolysis

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7
Q

How does the gallbladder sit in relation to the MCP?

A

Anterior

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8
Q

Choledocholithiasis?

A

Stones in the biliary duct

Enlargement/narrowing of biliary ducts

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9
Q

Cholelithiasis?

A

Stones in the gallbladder

Radiolucent/radiopaque/move around

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10
Q

Acute cholecystitits?

A

Inflammation

Thickened wall of gallbladder

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11
Q

Chronic cholecystitis?

A
  • chronic inflammation

- calcification of the wall of the gallbladder

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12
Q

Neoplasms

A

Mass seen within gallbladder, liver, biliary ducts

-extensive calcification of gallbladder wall

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13
Q

Biliary stenosis?

A

-elongation/tapering/narrowing of CBD

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14
Q

Alimentary canal?

A
  • oral cavity
  • pharynx
  • esophagus
  • stomach
  • small intestine
  • large intestine
  • anus
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15
Q

Accessory organs?

A
  • salivary glands
  • pancreas
  • liver
  • gallbladder
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16
Q

Functions of the alimentary canal?

A
  • intake/digestion of food, water, vitamins, minerals
  • absorb digested food particles
  • eliminate unused materials
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17
Q

Deglutition?

A

Swallowing

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18
Q

Mastication?

A

Chewing

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19
Q

Defecation?

A

Excretion

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20
Q

Salivary glands and their locations

A
  • Parotid: anterior to ear, largest
  • Submandibular: below mandible/maxilla
  • Sublingual: below tongue, most anterior
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21
Q

Mumps

A

Inflammation of the parotid glands

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22
Q

Is the nasopharynx part of the digestive system?

A

No

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23
Q

Borders of oropharynx?

A

-soft palate to epiglottis

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24
Q

Borders of laryngopharynx (hypopharynx)?

A

-epiglottis to lower border of the larynx (C6)

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25
Esophagus
- laryngopharynx to stomach - begins posterior to C5/C6 - ends at T11 - posterior to trachea, anterior to aorta and spine - passes through the diaphragm at T10
26
2 indents in the esophagus?
- aortic arch | - left primary bronchus
27
After the esophagus passes through the diaphragm, the distal portion right before the LES is the?
Cardiac antrum
28
Muscle of the esophagus?
Upper 1/3rd: well developed skeletal muscle Middle 1/3rd: skeletal and smooth muscle Lower 1/3rd: smooth muscle
29
What is peristalsis?
Involuntary muscular contractions that propel materials through the alimentary canal
30
What position best demonstrates the esophagus?
RAO
31
Parts of the stomach?
Fundus: posterior, “gastric bubble” when upright Body: curves inferior and anterior Pylorus: directed posteriorly
32
What separates the fundus and pylorus?
Angular notch
33
Parts of the pylorus?
- pyloric antrum: immediately distal to angular notch | - pyloric canal: narrow, ends at sphincter
34
Where are the rugae of the stomach most evident?
Along the greater curvature
35
What are rugae for?
Assist with mechanical digestion
36
What funnels fluids directly through the stomach?
Gastric canal along lesser curvature
37
Air/Barium distribution in different positions?
Supine: barium in fundus RAO recumbent: gas in fundus, barium in body and pylorus Prone: air in fundus
38
How long does it take to empty the stomach?
2-6hrs
39
How long does it take for things to pass through the small intestine?
3-5 hrs
40
What is the shortest and widest part of the small intestine?
Duodenum
41
**the duodenal bulb in intraperitoneal, but the rest of the duodenum is retroperitoneal**
.
42
What is the duodenaljejunal flexure held in place by?
Ligament of Treitz
43
Body habitus and organ position?
Sthenic: J shaped stomach T11-L2, duodenal bulb L1/L1 right of MSP, gallbladder midway between lateral abdomen and midline, high spenlic flexure Hypersthenic: high transverse colon, gallbladder is high and transverse, stomach high and tranverse T9-T12, duodenal bulb T11/T12 right of MSP Asthenic: low transverse colon, J shaped stomach T11-L5 or lower, duodenal bulb L3-L4, gallbladder at crests near midline
44
Other factors that affect position of the stomach?
- contents - respiration (fundus attached to diaphragm) - body position (upright vs supine) - previous abdominal surgeries
45
How much do organs drop when upright?
2.5-5cm
46
What parts of the alimentary canal can be seen without contrast?
- fundus (gastric bubble) | - parts of the large intestine (pockets of gas/feces)
47
Fluoro allows the radiologist to?
- observe the GI tract in motion - produce radiographic images during the exam - determine most appropriate course of action for a complete radiographic exam
48
Radiopaque contrast?
Barium sulfate | Water soluble
49
Radiolucent contrast?
-Co2, swallowed air (barium coats better with air)
50
Transit time of contrast depends on?
-consistency -temperature -suspending medium and additives -motile function of the alimentary canal (Water soluble has a shorter transit time)
51
Ratio of thin and thick barium
1:1 = thin | 3 or 4: 1 = thick
52
Contraindications for barium sulfate?
-any chance it would get into the peritoneal cavity (peritonitis)
53
Polyps, diverticula, ulcers are better seen with?
Double contrast
54
Radiation protection?
- lead drape shield for tower - bucky slot shield - lead aprons 0.5mm equivalency - use compression paddles instead of hands
55
3 rules of radiation protection?
- time - distance - shielding
56
Why do we do lay people down during an esophogram?
- demonstrates a hiatal hernia, if present - takes away gravity: must rely on peristalsis - demonstrates a barium filled esophagus better
57
How to demonstrate esophageal reflux?
- Breathing exercises (increase abdominal pressure): valsalva maneuver, mueller maneuver - Water test: LPO supine, swallow water, positive test = reflux - Compression technique: provide pressure to the stomach - Toe touch: reflux and hernias demonstrated
58
What is done to visualize esophageal varicies?
Valsalva maneuver
59
What best demonstrates the esophagus between the shadows of the heart and vertebra?
40 deg RAO
60
What is used to demonstrate air filled fundus on and asthenic patient?
AP partial trendelenberg
61
What is used to demonstrate a hiatal hernia?
Full trendelenberg
62
Why is an MBS performed?
To assess the patients ability to swallow
63
What make up the mucosal folds of the jejunum? What are they for?
Plicae circularis | Help increase surface area to air in absorption of materials
64
Difference between the colon and large intestine?
Colon DOES NOT include the cecum and rectum, only 4 sections and 2 flexures
65
What does the ileocecal valve do??
- acts as a sphincter - prevents too fast forward flow - prevents reflux
66
What is classed as the rectum?
The sigmoid colon to the anus, begins at S3
67
What is the rectal ampulla?
Dilated rectum anterior to the coccyx
68
Whats important to know about the rectum for enema tip insertion?
-2 anteroposterior curves
69
Barium in the large intestine for different positions?
Supine: air in the transverse colon and loops of sigmoid Prone: barium in the transverse colon
70
Functions of the intestines?
- Digestion (small) - Absorption (small) - Reabsorption (small/large) - Elimination (large)
71
What is rhythmic segmentation?
-localized contractions in areas with food
72
How does the small intestine move food?
- peristalsis | - rhythmic contractions
73
How does the large intestine move food?
- peristalsis - haustral churning - mass peristalsis - defecation
74
Most movement of organs from recumbent to upright occurs in what body habitus?
Hyposthenic/asthenic
75
Common water soluble contrast brand names
- gastrografin - hypaque - telebrix - conray
76
Which adheres better? Barium or water soluble?
Barium
77
What is a colostomy?
Surgically putting 2 parts of the intestines together after removing part
78
What is a stoma?
An artificial opening in the intestines (bag on the outside)
79
Parts of the urinary system?
- 2 kidneys (retroperitoneal) - 2 ureters (retroperitoneal) - 1 bladder - 1 urethra
80
How do the kidneys sit in the body?
- posterior to lower liver and spleen - 30 degrees anterior (lower pole more anterior) - upper pole closer to midline (i think 20 deg angle from MSP) - T12-L3 - move 1-4cm from inspiration to expiration - drop 5cm from recumbent to upright
81
Where do the ureters enter the bladder?
Posterolateral aspect
82
Functions of the urinary system?
- removed nitrogenous waste from the blood - regulate water levels in the body - regulate acid-base balance and electrolyte levels in the blood
83
Urinary system examinations?
- KUB - Intravenous Urography - Retrograde Urography - Cystography - Voiding Cystourethrogram - Percutaneous Catheter Nephrostomy
84
Indications for urinary system exams?
- renal calculi - chronic UTIs - urethral strictures - anatomic evaluation
85
Constriction points of the ureters?
- Ureteropelvic junction - Brim of pelvis (iliac blood vessel cross over ureter) - Ureterovesical junction (most common)
86
Methods of stone removal?
- Extracorporeal Shock Wave Lithotripsy - Laser Stone Fragmentation - Percutaneous Nepholithotomy (basket extraction or ultrasonic lithotripter)
87
Routes of contrast media administration?
- intravenously - direct injection - indwelling
88
Exams for the biliary system?
- Endoscopic Retrograde Cholangiopancreatography - Percutaneous Transhepatic Cholangiography - Intraoperative Cholangiogram
89
Purpose of an esophagram? Contraindications? Indications?
To demonstrate the form and function of the esophagus Contraindications: sensitivity to contrast media Indications: achalasia, anatomic anomalies, barretts esophagus, carcinoma, dysphagia, esophageal varicies, foreign bodies, GERD, Zenkers diverticulum
90
Prep and projections for an esophagram?
No prep - thin and thick barium used - AP/PA - Lateral - RAO/LPO - Optional swimmers
91
AP/PA esophagus
- CR 1” below sternal angle (T5/T6), top of IR 2” above shoulders - recumbent allows for more filling of the esophagus - strictures, foreign bodies, anatomic anomalies, neoplasms * *not as diagnostic as RAO** - expiration
92
Lateral Esophagus
- CR at T5/T6 along MCP - expose on expiration - barium filled esophagus seen between heart and vertebrae
93
RAO/LPO esophagus centering/rotation?
- CR at T5/T6 1” lateral to MSP on elevated side - 35-40 degrees rotation * 40 degrees best demonstrates* - esophagus between the heart and vertebrae
94
Other names for an upper GI?
- UGI - OS+D - Barium swallow - Barium Meal
95
Purpose of an upper GI? Contraindications? Indications?
To evaluate the form and function of the distal esophagus, stomach, and duodenum Contraindications: sensitivity to contrast, history of perforated bowel, laceration, or ruptured viscus Indications: Bezoar, diverticula, emesis, carcinoma, gastritis, hiatal hernia, hypertropic pyloric stenosis, ulcers
96
Upper GI prep and positions
- NPO from midnight to time of exam (at least 8hrs) - no smoking/chewing gum (increases gastric secretions) - RAO - PA - RT lateral - LPO - AP
97
RAO stomach and duodenum
Sthenic: CR @ L1, 45-55 degrees rotation Asthenic: CR 2” below L1, 40 degrees rotation Hypersthenic: CR 2” above L1, 70 degrees rotation -expiration
98
What is the best image of the pyloric canal and duodenal bulb in profile?
RAO stomach and duodenum
99
What will demonstrate a hiatal hernia, if present?
AP stomach
100
PA/AP stomach
Sthenic: CR @ L1 left of MSP Asthenic: CR 2” below L1 Hypersthenic: CR 2” above L1 nearer midline -barium filled stomach spreads more horizontal in PA
101
What is the alternate to an AP/PA stomach for hypersthenic people?
35-45 degrees cephalad angle
102
RT lateral stomach and duodenum
Sthenic: CR @ L1, 1-1.5” anterior to MCP Asthenic: CR 2” below L1 Hypersthenic: CR 2” above L1 -stomach, duodenum, *retrogastric space*, lateral vertebrae **stomach located 1 vertebrae higher than PA and oblique positions*
103
LPO stomach and duodenum
Sthenic: CR @ L1, 45 degrees Asthenic: CR 2” below L1, 30 degrees Hypersthenic: CR 2” below L1, 60 degrees -air filled pylorus and duodenal bulb- better demonstrate gastritis and ulcers
104
Small Bowel Follow Through
- NPO from midnight - pictures taken at specific time intervals - exam done after contrast reaches cecum
105
What is the “money shot” of the SBFT?
Terminal ileum
106
Centering for initial image of SBFT?
CR 4” above iliac crests to include entire stomach on image
107
Centering for all other images of SBFT?
CR @ crests and MSP
108
Why is PA better than AP on SBFT?
- less gonadal dose - less OID - compression on front separates bowel loops
109
What might the radiologist recommend if the contrast hasn’t reached the cecum after 4 hours?
- something to eat: peristalsis - cold water: flushes through - lay on right side: gravity
110
Enteroclysis?
- injection of a nutrient or medical liquid into the bowel by a special catheter passing through the nose to the duodenojejunal junction - pts with clinical histories of small bowel obstructions, Crohn’s disease, or celiac disease - evaluation of small bowel tumours - barium and methylcellulose or air
111
Why is methylcellulose preferred?
It adheres to and distends the bowel and enhances the visibility of the mucosa
112
Disadvantages of enteroclysis?
- increases patient discomfort - possibility of perforation with the NJ tube - potential of high radiation dose
113
Is enteroclysis or a regular SBFT better to see inflammatory bowel or Crohn’s?
Regular SBFT
114
What position helps advance the NG tube?
RAO
115
Another name for gastrointestinal intubation?
Small bowel enema
116
What is a gastrointestinal intubation?
-NG tube to jejunum Diagnostic: single lumen tube, barium or water soluble contrast, radiographs at times intervals Therapeutic: double lumen (miller abbott) to stomach to jejunum, relieve post op distention or decompress
117
Another name for barium enema?
BE | Lower GI
118
Why should we check if a patient has had a biopsy of the colon before a barium enema?
Weakened wall of intestine could cause perforation
119
Why do we administer glucagon/buscopan during a barium enema? How do we administer it? Who administers it?
- decrease spasms and peristalsis - IV/IM - Rad or nurse
120
Prep for barium enema? Indications?
- 2 day diet of clear liquids, laxatives or cleansing enema, NPO fro midnight the night before - scout to confirm prep - colitis, ulcerative colitis, diverticulum, intussusception, neoplasms, annular carcinoma, volvulus, cecal volvulus
121
Types of enema tips?
1. Plastic disposable (no balloon) 2. Plastic Disposable with retention (balloon) 3. Plastic disposable air contrast retention (balloon)
122
Projections for single contrast enema?
- AP/PA - LPO - RPO - Sigmoid/axial - Lateral rectum - Post evac
123
Projections for double contrast enema?
- AP/PA - Rt and Lt lateral decubitus - Obliques - Sigmoid/axial - lateral rectum - post evac
124
When are balloons inflated?
ONLY under fluoro as they could cause rupture
125
Why are there more projections for a double contrast enema than a single?
The barium moves faster through
126
AP/PA barium enema
- CR @ iliac crests - expiration - include to rectal ampulla
127
PA vs AP barium enema: where is the barium?
PA: barium in transverse colon AP: barium in ascending and descending colon
128
RAO barium enema
- 35-45 degrees rotation - CR @ crests, 1” LEFT of MSP - right hepatic (colic) flexure visualized - ascending colon and sigmoid colon
129
LAO barium enema
35-45 degrees rotation - CR @ iliac crests - left splenic (colic) flexure demonstrated - descending colon - may have to center higher to include high left flexure
130
RPO barium enema
35-35 degrees rotation - CR @ crests, 1: lateral to upside LEFT - left splenic (colic) flexure - may have to center higher to include high left flexure
131
LPO barium enema
35-45 degrees rotation CR @ crests, 1” lateral to upside (RIGHT) -right hepatic (colic) flexure
132
Right lateral Decubitus Barium enema
- CR @ crests - barium gravitates to right side - air: medial ascending and lateral descending * use a grid* - double contrast demonstrates more - expiration - include entire colon
133
Left lateral decubitus barium enema?
- CR @ crests - barium gravitates to left side - Air: medial descending and lateral ascending * use a grid* - expiration - include entire colon
134
Lateral Rectum
CR @ level of ASIS and MCP | -rectum and distal sigmoid demonstrated
135
What position is better for a double contrast lateral rectum? True laterals or decubitus?
Ventral decubitus
136
What is seen in a ventral decubitus lateral rectum?
-posterior rectum air filled
137
AP axial or axial oblique (LPO) for sigmoid
“Butterfly projection” - AP: CR @ 2” below ASIS - LPO: CR to exit at ASIS 2” medial to right ASIS (upside) - AP: 30-40 degrees cephalad - LPO: 30-40 degrees cephalad - rectosigmoid viewed with less overlap of sigmoid loops
138
PA axial or axial oblique (RAO) sigmoid
``` PA: CR to exit at ASIS RAO: CR @ ASIS, 2” left of MSP (upside) 30-40 degrees caudad **better than AP** -elongated view of rectosigmoid area ```
139
Post evacuation barium enema
- CR @ crests - demonstrates mucosal pattern of the large intestine with residual contrast media for identifying small polyps/defects - can be AP or PA (PA common) - if not enough evacuation, wait and take image again - coffee and tea can help move things along - lower kVp to prevent over penetration with only residual contrast remaining
140
Additional Sigmoid projection for barium enema (LPO)
- CR 10cm below and 10cm medial to right ASIS | - this view provides more elongation and less superimposition of rectosigmoid segments
141
Urinary procedures prep?
-NPO 8hrs before procedures so that no fecal material/gas is in the way
142
Purpose of KUB?
- verify patient prep was successful - determine acceptable exposure factors - verify positioning of structures - detect any abnormalities prior to contrast given
143
KUB
- CR @ crests - include T11-symph - expose on expiration
144
IVU: intravenous urography purpose
- to visualize collecting portion of the urinary system - to assess the functional ability of the kidneys - to evaluate the urinary system for pathology or anatomic anomalies
145
IVU contraindications?
- renal failure - diabetes with renal insufficiency - renal hypertension - CHF - prior reaction to contrast media
146
Indications for an IVU?
- abdominal masses - renal tumors/cysts - urolithiasis, pyelonephritis, hydronephrosis - trauma - pre-op evaluation
147
IVU procedure
- scout KUB taken - contrast injected via IV, note injection start time - 30s or 1min AP (kidneys) - 5min AP (kidneys) - 10 min AP full length - 20 Min obliques (30deg) CR at crests, 10cm lat to MSP - Post void PA or erect AP - radiologist assess after obliques and decides if ready for post void
148
How do we enhance visualization of the renal pelvis and calyceal filling and proximal ureters during and IVU?
Compression applied at level of ASIS
149
Purpose of retrograde urography?
- non-functional exam to determine the location of the undetected calculi/other obstruction - to view renal pelvis and calyces for signs of infection or structural defects
150
Retrograde urography procedure?
- can be unilateral or bilateral filling of ureters - uretercystoscope used by urologist - performed in OR - under sedation - surgical asepsis - AP image taken after contrast (water soluble) injection
151
Purpose of retrograde cystography
- performed to rule out tumours, calculi, trauma, inflammatory disease of the bladder - non-functional - performed in x-ray department
152
retrograde cystography procedure and projections?
- contrast administered by urinary catheter and aided by gravity only - AP axial bladder - Posterior oblique - PA axial bladder - Lateral
153
Indications for retrograde cystography?
- cystitis - obstruction - vescoureteral reflux - bladder calculi
154
AP axial bladder
- CR 2” superior to symph - 10-15 deg caudad - to demonstrate urinary reflux center higher @ iliac crests
155
Posterior oblique bladder
- CR 2” above symph and 2” medial to ASIS on the upside - 40-60 deg rotation - UV junction shown where ureter enters bladder on upside
156
Lateral bladder
- CR 2” superior and 2” posterior to symph - possible fistulas between the bladder and uterus/rectum can be visualized - demonstrated anterior and posterior walls of the bladder as well as the trigone (base) - not done often due to gonadal dose
157
Voiding cystourethrogram purpose and indications
- functional, evaluates patients ability to urinate/void | - incontinence, trauma, chronic UTIs, kidney infection, suspicious of reflux, bedwetting, difficulty toilet training
158
Voiding Cystourethrogram procedure and projections
- contrast into bladder through catheter by gravity only (no pressure) - Females: AP or slight oblique - Males: 30 deg RPO to superimpose urethra over soft tissue of thigh - post void AP may be requested - radiologist looking for reflux during voiding
159
Percutaneous Catheter Nephrostomy purpose
- invasive, therapeutic, establishes opening between the renal pelvis and patients skin - surgical asepsis - drainage, drug administration, instrumentation insertion
160
PCN procedure?
- guidewire inserted by needle into the calyces and sometimes down the ureter - dilators used to expand opening until catheter will fit - drainage bag attached
161
Risks of PCN
- infection - catheter dislodgement - catheter obstruction - hermorrhage
162
What is the follow up of a PCN?
Nephrostography: contrast is injected through the catheter
163
Extracorporeal Shock Wave Lithotripsy procedure
- non-invasive - shock waves from an electrical source to pulverize calculi - stones must be greater than 2mm in size - fragments pass down ureter (must not be obstructed)
164
Laser Stone Fragmentation precedure
- done in urology suite under general anesthetic - guidewire inserted into affected ureter - long scope inserted, stone disintegrated using laser
165
Percutaneous Nephrolithotripsy procedure
- invasive - incisions made into kidney for the removal of renal calculus - basket extraction: removed small, free floating calculi in kidney - ultrasonic lithotripter: rests against and vibrates to break it up
166
Hystersalpingography
- infertility - size, shape, and position of uterus and tubes - lesions, masses, and fistulas - performed by gynaecologist - contrast should spill into peritoneal cavity - ovaries not seen
167
ERCP: Endoscopic Retrograde Cholangiopancreatography purpose and procedure
- to diagnose biliary/pancreatic pathologies - can be diagnostic/therapeutic - gastroenterologist passes endoscope through mouth to duodenum - inserts cannula into ampulla of vater and injects contrast into CBD - “clean procedure” not sterile * should see spilling of contrast into duodenal bulb
168
Contraindications for an ERCP
- pancreatitis - pseudocyst of the pancreas - elevated creatinine/BUN - possible hypersensitivity to contrast
169
What position is patient in for insertion of endoscope? Cannula insertion?
LAO, moved into SIMS for cannula insertion
170
What images do we do if there is overlap of the CBD and pancreatic duct when doing an ERCP??
Oblique images
171
What is a therapeutic ERCP for
- stent placement - stone removal - expand narrowing of ducts
172
How is a tumour of the head of the pancreas indicated/demonstrated?
Displacement of the descending duodenum
173
PTC: Percutaneous Transhepatic Cholangiogram
- pre-operative - surgical asepsis - INR and PT known before - chiba needle inserted into biliary system to demonstrate hepatic ducts - contrast injected - AP spot films taken
174
What can be done if ERCP is contraindicated?
PTC
175
What are INR and PT for?
Blood clotting ability
176
Therapeutic PTC?
- if dilated ducts are identified by diagnostic PTC - drainage catheter inserted - used to drain or extract stones
177
Risk of a PTC?
- pneumothorax - liver hemorrhage - peritonitis
178
Operative cholangiogram purpose?
Investigates the patency of the biliary ducts, functional status of sphincter of oddi, presence of stones or lesions, strictures/dilatations of ducts
179
Operative cholangiogram procedure?
- performed in OR by surgeon - if surgeon is unsure if all stones removed, T-tube left in place - AP - RPO 15-20 trendelenberg to get ducts to fill - T-tube put in where gallbladder used to be

MRT Year 2 (18 decks)

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