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Oncology > Imaging > Flashcards

Imaging Flashcards

1
Q

Reasons for Imaging in the Management of Cancer

A 
Screening
Making the diagnosis
Staging
Operative planning
Response to treatment
Follow-up
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2
Q

Types of Imaging in Cancer

A 
Plain films
CT scans
Fluoroscopy
Mammography
SPECT scans
PET scans
MRI
Ultrasound
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3
Q

What are X-rays good for?

A

Lungs
Kidney/gall stones
Bones

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4
Q

X-rays not good for

A

Soft tissues

Brain

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5
Q

What do x-rays rely on?

A 
Differential absorption
Air
Fat
Water
Bone densities
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6
Q

Imaging for Bone Lesions

A

X-rays
CT scans
MRI
PET/CT

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7
Q

What are we looking at on x-rays for oncology imaging?

A 
Nature of the bone matrix
Interface of lesion & bone
Cortex intact?
What part of bone?
Benign vs. malignant
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8
Q

Define Benign Bone Lesions

A

Well-defined
No cortical destruction
No periosteal reaction

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9
Q

What are CT scans best for evaluating?

A

Subtle bone changes

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10
Q

What are MRI scans best for evaluation of?

A

Soft-tissue & infiltrative marrow lesions

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11
Q

Define Latent Bone Lesions

A

Surrounded by reactive cortical rim

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12
Q

Define Active Bone Lesions

A

Easily discernible transition without reactive rim

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13
Q

Define Aggressive Bone Lesions

A

Broad infiltrating border

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14
Q

Define Fluoroscopy

A

Continuous X-rays used to obtain real time moving images of internal structures

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15
Q

Define CT Scan

A

X-rays taken in several planes are computer processed to show images in multiple slices: AP, lateral, sagittal, x-section & even as 3D images

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16
Q

Advantages of CT Scancs

A

Differentiate structures of close physical density
Eliminates superimposition of organs
Show calcified & hemorrhagic lesions
Show in multiple planes or even as a 3D image

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17
Q

Advantages of CT Scans in Neoplastic Disease

A

Very good in the abdomen for staging
Very good for evaluation of masses in the chest
Can do virtual colonoscopy
Most intracranial neoplasms are visible

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18
Q

Disadvantages of CT Scans

A

Risk of cancer
Contrast: allergic reactions, anaphylaxis, nephropathy
Expensive
Observer variation

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19
Q

Define Pancoast’s Tumor

A

Extension of tumor at apex of the lung involving C8, T1, T2 nerves & possible destruction of ribs

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20
Q

Presentation of Pancoast’s Tumor

A

Shoulder pain radiating in the ulnar direction

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21
Q

Virtual Colonoscopy

A 
Done with CT
Requires bowel prep
No sedation needed
Not as sensitive as colonoscopy
Can't do biopsies
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22
Q

Mammography

A

Uses low energy X-rays to generate images

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23
Q

Abnormal Mammogram

A 
Needs breast examination
Further mammography for confirmation
Ultrasound for better definition
BIRAD classification
MRI with gadolinium- implants very dense
Needle/surgical biopsy may be recommended
Tissue diagnosis key
24
Q

What do nuclear scans measure?

A

Bone metabolism or remodeling

25
Q

Nuclear Scans

A 
Radio-isotope injected IV
3 hours later, the patient is scanned
Provides 2D image
Function test
Half material goes to the bones
Eliminated through the kidneys
26
Q

Bone Scans

A

Show increased metabolic activity or increase blood flow
Assess activity or known lesions
Find unknown lesions
Overestimates lesions
MM cold scan until cortical disruption occurs

27
Q

What does PET stand for?

A

Positron emission tomography

28
Q

What can a PET be combined with?

A

CT

MRI

29
Q

When are PET scans especially useful?

A

Lymphomas

Lung CA

30
Q

PET Scans

A

Detects active, rapidly growing tumors

Higher grade malignancies detected more than benign processes

31
Q

What does SPECT stand for?

A

Single Photon Emission Computer-Assisted Tomography

32
Q

What is a SPECT scan good for?

A

Small spinal lesions
Osteoid osteoma
Osteoblastoma

33
Q

How do MRI machines work?

A

Powerful magnets excite H+ protons to emit measurable electromagnetic radiation

34
Q

Different MRI Techniques

A

Angiography
Functional MRI
Diffusion MRI
CSF dynamics

35
Q

Disadvantages of MRIs

A 
Expensive
Slow
Claustrophobia
Pacemakers, stents
Small metal fragments
Metal artifact
Need a calm patient
May be genotoxic
36
Q

MRI of the Spine

A

Radiation free
Superior for soft tissue imaging
Can see subtle differences
Gadolinium assists in delineating surrounding vascularity

37
Q

Ultrasound

A

High frequency sound waves
Reflect & echo off of tissues
Processed in ultrasonic scanner
Usually seen as 2D image

38
Q

Advantages of Ultrasound

A

Cheap, quick, easy, safe, comfortable
Shows solids, fluids, muscle, tendon, bone surface
Hampered by bone, air, fat

39
Q

Disadvantage of Ultrasound

A

Operator dependent

40
Q

When to Use Ultrasound

A

Thyroid tumors/lesions (test of choice)

Supplement mammography

41
Q

How to make a cancer diagnosis?

A

Tissue: open biopsy or needle biopsy

42
Q

Lung Biopsy Complications

A

Pneumothorax

Hemoptysis

43
Q

Which cancers primarily metastasize to the bones?

A

Breast
Prostate
Lung
Kidney

44
Q

Where are spine mets typically seen?

A

Base of pedicle

Unilateral destruction of pedicle “winking owl sign”

45
Q

Define Pathologic Fractures

A

Occur through area of weakened bone: osteoporosis, benign cystic tumor, malignant tumor

46
Q

PROs of X-ray

A

Simple
Inexpensive
Readily available
Easily interpreted

47
Q

CONs of X-ray

A

Radiation
Poor tissue contrast
Technician dependent
2D

48
Q

PROs of CT Scans

A

Rapid
3D capability
Axial imaging
Good bony detail

49
Q

CONs of CT Scans

A

Highest radiation
Motion & metal artifact
Limited ST contrast

50
Q

PROs of Bone Scans

A

Images metabolic activity
Very sensitive in bones
Low cost

51
Q

CONs of Bone Scans

A

Non-specific
Poor detail
Anatomic changes not visualized

52
Q

PRO of MRI

A

Superior tissue resolution

53
Q

CONs of MRI

A

Expensive
Motion & metal artifact
Can’t use in some patients

54
Q

PROs of PET/CT or MRI

A

Combines function & anatomy

Best for most cancers

55
Q

CONs of PET/CT or MRI

A

Expensive (pre-auth)

56
Q

PROs for Ultrasound

A

Very safe
Inexpensive
Quick

57
Q

CONs for Ultrasound

A

Small field of view
Technician & radiologist dependent
Artifacts

Oncology (11 decks)

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