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MRT Year 1 Semester 2 > Fluoro Final Exam Review > Flashcards

Fluoro Final Exam Review Flashcards

1
Q

3 ways to inject contrast media?

A
  • Indwelling
  • Direct
  • Intravenously
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2
Q

Which exam requires direct puncture of the biliary ducts?

A

Percutaneous transhepatic cholangiogram

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3
Q

Functions of the gallbladder?

A
  • store bile
  • concentrate bile
  • secrete bile
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4
Q

Purpose of an operative cholangiogram?

A
  • investigate patency of biliary ducts
  • functionality of sphincter
  • presence of stones, stricture, or dilatations
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5
Q

Advantages of laparoscopic surgery over operative cholecystectomy?

A
  • less pain
  • faster recovery
  • less time in hospital
  • smaller incisions
  • cost savings
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6
Q

Biliary system exams?

A
  • Endoscopic retrograde cholangiopancreatography
  • Percutaneous Trashepatic Cholangiogram
  • Operative cholangiography
  • Post-operative cholangiography
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7
Q

Purpose of a diagnostic ERCP?

A
  • demonstrate strictures, dilatations, or small lesions within the biliary or pancreatic ducts
  • check patency of biliary and pancreatic ducts
  • visualize stones or narrow duct
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8
Q

Purpose of a therapeutic ERCP?

A
  • removal of small lesions
  • removal of stones
  • dilate a blocked or narrowed duct
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9
Q

Contraindications of an ERCP?

A
  • pseudocyst of pancreas
  • acute infections of the biliary system (pancreatitis)
  • hypersensitivity to contrast
  • elevated creatinine or BUN
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10
Q

Dense contrast may obscure ________. What can we do to fix this?

A

Small stones. Dilute the contrast

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11
Q

Prep for an ERCP?

A

NPO for at least 1hr prior to prevent aspiration

NPO for 10 hrs post to prevent irritation

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12
Q

Who is a PTC performed by?

A

Radiologist, tech, and nurse

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13
Q

Indications for a PTC?

A
  • jaundice
  • dilated ducts
  • unclear as to why there is an obstruction
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14
Q

Possible complications of a PTC?

A
  • pneumothorax
  • liver hemorrhage
  • peritonitis
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15
Q

Purpose of a PTC

A

To demonstrate the biliary ducts

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16
Q

What images are taken for a PTC?

A

AP spot films

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17
Q

What kind of needle is used for a diagnostic PTC?

A

Chiba

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18
Q

Purpose of a therapeutic PTC?

A

To remove stones

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19
Q

Purpose of an operative cholangiogram?

A
  • patency of ducts
  • functionality of sphincter
  • presence of stones
  • presence of strictures or dilatations
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20
Q

Exposures taken for an operative cholangiogram?

A
  • AP

- RPO: 15-20 deg

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21
Q

Where is an operative cholangiogram performed?

A

In the OR by the surgeon, surgical asepsis

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22
Q

Where is a post-operative cholangiogram performed?

A

In the radiology department

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23
Q

What may be required to fill the intrahepatic ducts with contrast?

A

Trendelenberg

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24
Q

What exam can be done if patient is contraindicated for an ERCP?

A

PTC

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25
Q

Which part of the kidney is more posterior?

A

Superior

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26
Q

How much do the kidneys move between inspiration and expiration?

A

1-4cm

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27
Q

How much do the kidneys move from supine to upright?

A

5cm

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28
Q

At what vertebral levels do the kidneys lie?

A

T12-L3

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29
Q

Urinary system exams?

A
  • KUB
  • IVU
  • Retrograde urography
  • Cystography
  • VCUG
  • PCN
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30
Q

Indications for a urinary study?

A
  • renal calculi
  • chronic urinary tract infections
  • urethral strictures
  • anatomic evaluation of the renal pelvis, calyces, and ureters
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31
Q

Locations of ureter contrictions?

A
  • Vesicoureteral junction
  • Ureteropelvic junctions
  • Brim of pelvis
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32
Q

What modality is becoming more common to discover kidney stones? Why?

A

CT

  • safe, less invasive, no contrast used
  • accurate
  • disadvantage is high dose and not always available
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33
Q

Prep for urinary studies?

A
  • NPO 8hrs prior

- bowel cleansing required to avoid gas and fecal shadows

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34
Q

Purpose of the KUB?

A
  • verify patient prep was successful
  • determine exposure factors
  • verify position of structures
  • detect any abnormalities
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35
Q

Positioning for KUB?

A
  • supine
  • CR at crests (L4)
  • collimate to ASIS
  • include kidneys to symph
  • expose on expiration
  • male shielding below superior margin of symph
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36
Q

Purpose of an IVU?

A
  • visualize collecting portion of the urinary system
  • assess functional ability of the kidneys
  • evaluate the urinary system for pathologies or anatomic anomalies
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37
Q

Indications for an IVU?

A
  • abdominal masses
  • renal tumour/cysts
  • urolithiasis
  • pyelonephritis
  • hydronephrosis
  • trauma
  • pre-op evaluation
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38
Q

Contraindications for IVU?

A
  • renal failure
  • renal insufficiency
  • renal hypertension
  • CHF
  • prior contrast reaction
  • anuria
  • sickle cell anemia
  • multiple myeloma
  • Pheochromocytoma
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39
Q

What medication must be stopped for 48hrs post-contrast?

A

Glucophage

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40
Q

Routine projections for an IVU?

A
  • 30sec to 1 min AP (nephrogram, kidneys only)
  • 5 min AP kidney
  • 10 min AP (full)
  • 20 min obliques (full)
  • Post void
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41
Q

AP kidney positioning

A
  • CR midway between xiphoid and crests (L1)
  • bottom of IR at crests (24x30)
  • include time marker
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42
Q

Oblique positioning for IVU?

A
  • posterior obliques
  • 30 deg rotation on patient
  • CR at level of crests, 10 cm lateral to elevated side
  • expiration
  • time marker
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43
Q

Why do we use compression?

A

Allows for visualization of the renal pelvis and calyceal filling and proximal ureters

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44
Q

Contraindications of compression?

A
  • stones
  • recent surgery
  • pelvis mass/tumor
  • aneurysms
  • trauma
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45
Q

Purpose of retrograde urography?

A
  • to determine location of undetected stones or other obstruction
  • to view renal pelvis and calyces for signs of infection or structural defect
46
Q

Where is retrograde urography performed?

A

In the OR by a surgeon, surgical asepsis

47
Q

Images for retrograde urography?

A

AP, no set time interval, urologist instructions

48
Q

Indications for bladder exams?

A
  • vesicoureteral reflux
  • recurrent UTI
  • neurogenic bladder
  • bladder trauma
  • fistulas
  • urethral stricture and posterior urethral valves
49
Q

Purpose of retrograde cystography?

A

-rule out tumours, stones, trauma, and inflammatory diseases of the bladder

50
Q

Where is retrograde cystography performed?

A

In the x-ray department by a radiologist

51
Q

What happens if you try to introduce contrast under pressure to the bladder?

A

It could rupture

52
Q

Cystogram projections?

A
  • AP axial bladder
  • Posterior obliques
  • PA axial bladder
  • Lateral
53
Q

AP Axial bladder positioning?

A
  • supine
  • 10-15 deg caudad
  • CR 5 cm above symph
  • expiration
  • urinary bladder not superimposed by bones
  • distal ureters and proximal portion of urethra demonstrated
54
Q

PA Axial Bladder

A
  • prone
  • 10-15 deg cephalad
  • CR 2.5cm distal to tip of coccyx
  • expiration
55
Q

Posterior oblique bladder positioning?

A
  • 40-60 deg patient rotation
  • CR 5cm above symph and 5cm medial to elevated ASIS
  • expiration
  • distal ureters (UV junction on upside), bladder, and proximal portion of urethra demonstrated
56
Q

Lateral bladder positioning?

A
  • true lateral
  • CR 5cm above symph and 5cm posterior to symph
  • expiration
  • anterior, posterior, and base of bladder
57
Q

Purpose of a VCUG?

A

Evaluate patients ability to void

58
Q

Difference in positioning for a male vs. a female for a VCUG?

A

Female: AP or slight oblique
Male: 30 deg RPO

59
Q

Purpose of a Percutaneous catheter nephrostomy?

A
  • drainage
  • drug instillation
  • instrument insertion
60
Q

Complications of a PCN?

A
  • infection
  • catheter obstruction
  • catheter dislodgment
  • hemorrhage
61
Q

What is the follow up of a PCN called?

A

Nephrostography

62
Q

Methods of stone removal?

A
  • extracorporeal shock wave lithotripsy
  • laser stone fragmentation
  • percutaneous nephrolithotomy
63
Q

Extracorporeal shock wave lothotripsy

A
  • non invasive
  • stones must be less than 2mm in size
  • uses shock waves from an electrical source to pulverize stone
  • ureter must not be obstructed
64
Q

What are taken before a ESWL?

A
  • prelim abdomen film

- IVU

65
Q

Where is Laser stone fragmentation performed? What does it entail?

A

In the urology suite under general anesthetic

-scope in inserted into ureter and laser is blasted at stone

66
Q

What is percutaneous nephrolithotomy?

A
  • incision made into kidney to remove the stone
  • basket extraction to remove small stones
  • ultrasonic lithotripter to break up large stones
67
Q

Purpose of a hysterosalpingogram?

A

Size, shape, and position of uterus and tubes

68
Q

Most common indication of a hysterosalpingogram?

A

Infertility

69
Q

What is fluoroscopy?

A

Real-time dynamic viewing of anatomical functions using x-ray

70
Q

What effect does increasing kVp have on dose?

A
  • decrease dose if mA remains the same because less if absorbed
  • increase dose because we have less penetrability and will need to compensate by increasing mA
71
Q

List come procedures that would utilize fluoroscopy?

A
  • BE
  • SBFT
  • Esophageal studies
  • Arthrograms
  • Angiography
  • Biliary system exams
  • Genitourinary system exams
  • OR cases
  • Pacemaker insertions
  • Hip pinnings
72
Q

Normal range of kVp used to perform fluoro exams on adults?

A

75-110 kVp

73
Q

How does SID affect dose

A

-increased SID = decreased dose

74
Q

How does OID affect dose?

A

-increased OID = increased dose because decreased distance to source

75
Q

What are quantity and quality?

A

Quantity: amount of x-ray photons, mA
Quality: strength of x-rays, kVp

76
Q

How does focal spot affect dose?

A

It doesn’t

77
Q

What is the most effective mechanical methods of decreasing patient dose?

A

Collimation

78
Q

How does filtration effect dose?

A

-increased filtration = decreased dose because it absorbs low energy photons

79
Q

Why can’t we achieve the ideal combo of technical factors?

A

We have to maintain a balance between dose and image quality

80
Q

How do grids affect dose?

A

Grid = increased dose because we have to raise out mA

81
Q

What are stochastic effects?

A

“Probabilistic”

  • no threshold
  • increased chance with increased dose
82
Q

What are non-stochastic effects?

A

“Deterministic”

  • have a threshold
  • increased severity with increased dose
83
Q

What is a somatic effect?

A

The effects only take place in the person irradiated

84
Q

4 main components of the I.I

A
  1. Input phosphor: converts radiation to light
  2. Photocathode: converts light to electrons
  3. Electrostatic Focusing lenses: direct electrons towards anode
  4. Anode: attracts electrons emitted from photocathode
  5. Output phosphor: receives electrons, emits light
  6. Glass envelope: maintains vacuum
85
Q

How does mag mode affect dose?

A

Increased it because the image appears dimmer due to decreased photoelectrons on the output phosphor so we need to increase out mA to compensate

86
Q

When the I.I is closest to the patient, the dose _______?

A

Decreases

87
Q

What are the advantage of digital fluoro over conventional that can be used to decrease dose?

A
  • pulsed fluroscopy
  • last image hold
  • pulsed progressive fluoro
88
Q

When is cinefluorography used? Why is it bad?

A
  • cardiology
  • neuroradiology
  • uses a higher tube voltage and current
89
Q

Purpose of the I.I?

A

Increase the brightness on the screen

90
Q

Benefits of an I.I?

A
  • increased brightness
  • rads don’t need to adjust to dark
  • improves visual acuity
  • reduces technical factors
91
Q

Advantages of mag mode

A
  • increased spatial resolution

- increased contrast resolution

92
Q

How does pulsed fluoro work?

A

When the beam is off the output screen in scanned and the image appears on the monitor, radiation is pulsed back on for the next image

93
Q

As value increases the I.I flux gain _______?

A

Decreases

94
Q

Air kerma exposure rate limitation?

A
  • With ABC: 50mGy/min

- Without ABC: 100mGy/min

95
Q

Purpose of filtration

A

To reduce skin dose

96
Q

Minimum filtration?

A

2.5mm Al

With I.I, 3.0mm or higher

97
Q

What is a mandatory function that all units must have as stated in the SC35?

A

Chronometer

98
Q

Max entrance skin exposure rate?

A

-100mGy/min

99
Q

Intensity at tabletop should not exceed?

A

-21mGy/min

100
Q

Units with high level control may have a skin exposure rate of?

A

-200mGy/min

101
Q

What is DAP

A

Dose area product: reflect the dose and area of radiation

102
Q

DAP increases as field size _______

A

Increases

103
Q

What are DRLs used for?

A

To promote better control of patient exposure, used as a guideline not a limit

104
Q

DRLs

A

Abdomen: 20-70Gy/cm
BE: 30-60Gy/cm
Coronary Angriography: 35-75Gy/cm

105
Q

What is high level fluoro used for?

A

Interventional procedures: drainage, biopsy, angiography

106
Q

High level fluoro dose is controlled by?

A

Frame speed. Lower frame speed = lower dose

107
Q

To best monitor effects in dose we must be diligent in?

A
  • patient monitoring
  • radiation dosimetry
  • accurate record keeping of dose levels
108
Q

Protective barriers?

A
  • Detectors slot cover: 0.25mm Pb
  • Protective curtain: 0.25mm Pb
  • I.I housing: 2mm of Pb
109
Q

Occupational dose comes from?

A
  • long exposure times
  • failure to use protective curtain
  • extensive use of cine as a recording medium
110
Q

We can reduce tech dose by?

A
  • rotating tech sched
  • use lead aprons
  • use mobile shields
  • use bucky slot shielding devices
  • keep hands out of beam
  • be aware of body position with respect to beam
  • stand behind control booth when possible
111
Q

Q/C

A
  • Exposure linearity: constant output for various mAs combos, within 10%
  • Exposure reproducibility: sequential exposures, within 10%
  • Protective apparel testing: cracks, tears, or holes

MRT Year 1 Semester 2 (11 decks)

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