Imaging and Oncology Flashcards
Imaging in the Management of Cancer: Indications for Imaging?
- Screening
- Making the diagnosis
- Staging
- Operative planning
- Response to treatment
- Follow-up (recurrence)
- What kind of X-rays are used for cancer dx?
- Bone scans options? 2
- What are the other two imaging options? 2
1.
- Plain films
- CT scans
- Fluoroscopy
- Mammography
2. Bone scans - SPECT scans
- PET scans
3.
- MRI
- Ultrasound
XRAYS
- Relies on what for imaging?
- Ionizing radiation can cause what complications? 2
- Good for what? 5
- Not as good for what? 2
- Disadvantage?
- Relies on differential absorption
- air, fat, water, bone densities - Ionizing radiation can damage tissue
- developmental issues,
- cancer - Good for
- lungs,
- kidney/gall stones,
- bones
- anywhere there are air/fluid contrasts
- or bone/soft tissue contrasts - Not as good for
- soft tissues
- brain - Pathology can be hidden by normal structures
What is going on in each film?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/948/048/q_image_thumb.png?1462291118)
1 Normal PA chest film
2 Mediastinal masses – lymph nodes
What is going on in each film?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/948/147/q_image_thumb.png?1462291184)
On the right – solitary nodule, might be benign or resectable
On the left - pulmonary mets from rectosigmoid cancer
What is going on in the CXR below?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/948/223/q_image_thumb.png?1462291242)
Small nodule by right main stem bronchus
What is going on in the picture below?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/948/640/q_image_thumb.png?1462291321)
LARGE TUMOR L UPPER LOBE WITH IRREGULAR EDGES, LUNG CANCER
What is going on in the pic below?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/948/743/q_image_thumb.png?1462291369)
Probable Diagnosis
BRONCHOALVEOLAR CELL CARCINOMA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/948/883/q_image_thumb.png?1462291436)
Irregular mass in the central portion upper lobe of the right lung lung cancer
- What is the most valuable initial imaging technique for bone lesions?
- What should we look at with the imgaing we ordered? 4
- What will a benign finding look like?
- What will a malignant finding look like?
- X-RAYS most valuable initial imaging technique
2.
- Look at the nature of the bone matrix
- Look at interface of lesion and bone
- Is the cortex intact? Which part of the bone is involved?
- Most lesions at metaphysis near major growth centers
3. Benign: Well-defined, no cortical destruction or periosteal reaction
4. Malignant: Ill-defined, destructive, infiltrative, lytic or blastic
- What are CT scans best at evaluating? 2
- MRI is good for what? 2
- Bone scans are good for what? 2
- CT SCANS
- best for evaluating subtle bone changes
- Good for areas hard to see on plain films - MRI better for
- soft-tissue and
- infiltrative marrow lesions - BONE SCANS
- show metabolic activity, looking for metastases
- PET/CT becoming imaging of choice
What is going on in each of the following pictures?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/218/q_image_thumb.png?1462291687)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/218/a_image_thumb.png?1462291705)
- What are latent lesions surrounded by?
- How would you describe active lesions?
- How would you describe aggressive lesions?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/274/a_image_thumb.png?1462291815)
What is the following picture showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/332/q_image_thumb.png?1462291856)
Extra-cortical involvement
- DDx for bone lesions? 4
- DDx for aggressive bone lesions? 3
- In general
- trauma,
- benign lesions
- infection,
- inflammatory condition - Aggressive bone lesions:
- metastatic tumor
- primary malignant bone tumor
- infection
What are the following pictures showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/472/q_image_thumb.png?1462292019)
- LYTIC AREA BELOW PHYSIS AND IN METAPHYSIS AND PERIOSTEAL NEW BONE – LEUKEMIA
- LOCULATED CYSTIC TUMOR DISTAL RADIUS – CORTEX EXPANDED BUT INTACT – GIANT CELL TUMOR
- DIFFUSE LYTIC PROCESS DISTAL RADIUS - OSTEOMYELITIS
What are the following showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/594/q_image_thumb.png?1462292075)
- Bone forming tumor extending past cortex and invading soft tissues, osteogenic sarcoma
- and 3. benign appearing lytic lesion distal tibia – non-ossifying fibroma
- Blastic lesions throughout the pelvis – prostatic CA
- Multiple ytic lesions of pelvis and femurs – multiple myeloma
- What is Fluoroscopy?
- Can be used to help with what?
- Prolonged procedures can lead to what?
- Small risk of what?
- Continuous X-rays used to obtain real time moving images of internal structures
- Can use to help guide fine needle biopsies
- Prolonged procedures can lead to skin burns
- Small cancer risk
Upper GI studies are a combination of what?
Contrast allows for exam of what? 3
Evaluation of which pathologies? 5
- Barium swallow + fluoroscopy
- Contrast allows for exam of
- esophagus,
- stomach, and
- duodenum - Evaluation of
- ulcers,
- GERD,
- vomiting,
- blood loss,
- hiatal hernia
What are the following pictures showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/949/760/q_image_thumb.png?1462292323)
1 & 2. - irregular mass encroaching into the lumen of the esophagus – esophageal cancer
- Irregular mass partially filling the stomach – gastric cancer
- Smooth outpouching from the esophagus – benign diverticulum
- CT scans are part of what other scans? 2
- Subject to what? 2
- When do you get your best images?
- Part of PET and SPECT scans.
- Subject to artifacts and distortion
- Best images with highest doses
of radiation
Advantages of CT scans
8
Greater detail than regular x-rays
- Can differentiate structures of close physical density
- Eliminates superimposition of organs
- Show calcified and hemorrhagic lesions
- Can be shown in multiple planes or even as a 3D image
Particular use in neoplastic disease
- Very good in the abdomen for staging
- Very good for evaluation of masses in the chest
- Can do virtual colonoscopy – screening for colorectal tumors
- Most intracranial neoplasms are visible on CT
CT Scans….Downsides
4
- Risk of cancer (may increase as CTs used more)
radiation dose of abdominal CT scan = 200 chest x-rays
1 study, 0.4% of cancers in US due CT (29,000/year)
- worse in children and immunocompromised patients
2. When contrast agents used
allergic reactions: 1-3% non-ionic and 7-12% ionic contrast agent
anaphylaxis: old ionic agents 1%, now 2-30/million
contrast-induced nephropathy in 2-7%
- Expensive
- Observer variation
What do you see in the following?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/950/202/q_image_thumb.png?1462292570)
Left – smooth – benign
Right – spiculated, infiltrative margin – bronchiole leads to it
What do you see in the following?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/950/251/q_image_thumb.png?1462292667)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/950/251/a_image_thumb.png?1462292683)
What do you see in the following?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/950/388/q_image_thumb.png?1462292759)
Irregular mass with infiltrations, perhaps to the pleura
Peripheral lesion – pleuritic chest pain – could be asymptomatic
- What are pancoast’s tumors?
- What kind of pain?
- Extension of tumor at apex of the lung involving C8, T1, T2, nerves and possible destruction of ribs
- Shoulder pain radiating in the ulnar distribution
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/950/436/a_image_thumb.png?1462293033)
What is happening in the following picture?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/187/950/848/q_image_thumb.png?1462293076)
BRONCHOALVEOLAR CELL CARCINOMA