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Imaging in cancer Flashcards

1
Q

What are some of the image technique that can be used in diagnosing and staging cancer? (5)

A
  1. plan radiographs
  2. barium studies
  3. CT
  4. MRI
  5. PET
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2
Q

What are the conventional diagnostic modalities? (2)

A
  1. endoscopy and biopsy

2. barium examinations

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3
Q

What is the radio-opaque contrast used for outlining the gastro-intestinal tract?

A

barium sulphate

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4
Q

why is barium used especially?

A

it has a high atomic number which means it absorbs more x ray photons than surrounding tissues

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5
Q

what colour does barium appear on a radiograph?

A

white

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6
Q

what does barium swallow and meal outline in the barium studies?

A

oesophagus, stomach and duodenum

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7
Q

What does barium follow-through or small bowel study outline in the barium studies?

A

small bowel

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8
Q

what does barium enema outline in the barium studies?

A

large bowel (large intestine)

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9
Q

how long does the patient have to fast for to have barium studies?

A

4-6 hours

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10
Q

What 2 things need to be done before a barium enema?

A
  1. low reside diet for 48 hours

2. bowel cleansing with Picolax

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11
Q

Outline the steps of a barium enema (8)

A
  1. tube inserted into rectum
  2. barium, water and air is run into descending colon/small int. to splenic flexure
  3. barium coats the colon
  4. patient turned onto right side
  5. barium is let out though the tube
  6. bowel is inflated with air
  7. column of contrast is pushed forward to caecum (pouch between large and small intestine) by air 8. imagine in different planes take can be taken as contrast shows clear images
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12
Q

What other, more invasive procedure is avoided by doing barium enema?

A

Colonoscopy

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13
Q

What can barium enema diagnose?

A
  • lower GI tract disorders e.g. can detect rectal carcinoma

- can also explain pain, constipation or blood in stool

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14
Q

what are main advantages of a barium enema? (5)

A
  1. more invasive procedures like colonoscopy avoided (it’s less invasive)
  2. less complications (e.g. allergic reactions)
  3. no radiation in body after x ray examination
  4. barium not absorbed into blood
  5. x rays usually have no side effects
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15
Q

What are some disadvantages of a barium enema? (4)

A
  1. still chance of cancer development since little exposure to radiation
  2. Ba could leak into surrounding tissues if hole in GI tract causing inflammation
  3. barium impaction (obstruction) in GI tract can occur
  4. effect of radiation dose varies from patient
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16
Q

what are the 3 main cross sectional imaging techniques?

A
  1. CT
  2. MRI
  3. PET
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17
Q

what can cross sectional imaging reveal? (5)

A
  1. Initial DIAGNOSIS and STAGING of cancer
  2. monitoring response to treatment
  3. evaluation of residual mass after treatment
  4. recognition of complications of treatment
  5. when there is concern for disease relapse
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18
Q

In a CT, x -rays produce a digital image of a slice of tissue using computing, in what plane?

A

Transverse plane (axial)

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19
Q

What units does CT scanning use?

A

Hounsfield Unit

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20
Q

What is a Hounsfield unit?

A

attenuation values of voxels expressed as a CT number relating to attenuation value of water

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21
Q

What is attenuation number of water?

A

0

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22
Q

what is attenuation number of blood and muscle?

A

+40

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23
Q

what is attenuation number of calcium?

A

+150

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24
Q

what is attenuation number of bone?

A

700-3000

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25
what is attenuation number of air?
-1000
26
what is attenuation number of lungs?
-700
27
what is attenuation number of fat?
-100
28
how does CT scanning work?
different parts of the body absorb x rays in different degrees, and difference in absorption is what allows body parts to be distinguishable
29
what colour are bones in a CT scan?
white
30
what colour do soft tissue structures such as organs appear in a CT?
shades of grey
31
what colour does air appear in a CT?
black
32
through what 2 ways are CT contrasts given to patients?
1. orally | 2. intravenously
33
what is the oral contrast used for a CT scan?
dilute iodine base contrast (gastrografin) can be given to outline GI tract
34
what is the intravenous contrast used for a CT scan?
iodine based contrast (Omnipaque) is injected into veins to demonstrate blood vessels/ vascularity of different tissues
35
What is the slight disadvantage to using iodine as a contrast in CT scanning?
Occasionally allergic and anaphylactic reactions with IV contrast occur
36
what are the main 5 things that CT scanning reveals to doctors?
1. position of tumour 2. depth of penetration of tumour 3. relationship to adjacent structure 4. involvement of regional lymph nodes 5. presence of distant metastases
37
what 3 sites is CT ONLY used for to reveal site of malignancy?
1. pancreas 2. upper urinary tract 3. testes
38
What system ONLY uses MRI scanning?
CNS (spinal cord)
39
what are some tumour diagnoses CT scanning can make? (6)
lung, pancreatic, renal, adrenal, retroperitoneal (space in abdomen) and brain tumours
40
what is assessed to determine tumour local spread? (2)
1. lymph nodes | 2. adjacent organs
41
what is assessed to determine distant spread?
Other body organs (e.g. liver, lungs, brain, bone and adrenal glands)
42
what are some benefits to CT scanning? (5)
1. non-invasive and painless 2. can image blood vessels, soft tissue and bone at the same time 3. detailed images 4. less sensitive to patient movement than MRI 5. no radiation remains in patient's body after CT scan
43
what are some disadvantages to CT scanning? (3)
1. effective dose varies from patient 2. not suitable for pregnant women 3. allergy to iodine rare but can still happen
44
in terms of monitoring disease, what is CT scanning good for?
1. response to treatment 2. relapse 3. progression of disease
45
what is the CT radiation dose for the chest?
8mSv
46
what is the CT radiation dose for abdomen and pelvis?
10mSv
47
what does ALARA stand for?
As low as reasonably possible
48
what does ALARA ensure?
1. ensure whether examination is necessary 2. adequate clinical information for appropriate protocol is needed 3. avoids repeated examinations
49
how does MRI screening work? (3)
1. strong magnetic field aligns protons in the body in one direction 2. radiofrequency pulse displaces protons 3. images created by displaying time taken for protons to "relax" back to original alignment
50
what does MRI screen for?
- soft tissue details (excellent) - vessels - brain, spine and muscoskeletal - abdomen and pelvis - cardiac imaging
51
what are some disadvantages to MRI? (3)
- claustrophobic and noisy - motion artefact - cannot image patients with pacemakers or aneurysm clips
52
can MRI be used for pregnant women?
Mainly yes
53
what is the MRI contrast agent?
Godolinium DPTA
54
what does godolinium DPTA cause in the body?
changes in local magnetic field, so alters tissue signal
55
how is godolinium DPTA administered to patients?
Intravenously
56
what are the NHS 3 main screening programmes?
- cervical - bowel - breast
57
what are the main rules surrounding screening generally? (4)
1. should detect disease at an early stage 2. test should cause no harm 3. should have high sensitivity and specificity 4. benefit to individual and population should outweigh the cost
58
When is CT mainly used? (3)
- Suited for bone injuries, -Lung and Chest imaging, cancer detection. - Widely used on Emergency Room patients
59
when is MRI mainly used?
-Suited for Soft tissue evaluation, e.g., ligament and tendon injury, spinal cord injury, brain tumors, etc.
60
What does CT stand for?
Computed (axial) Tomography
61
What does MRI stand for?
Magnetic resonance imaging
62
does CT use x-rays for its imaging while MRI doesn't?
yes
63
What structures in the body can use both CT and MRI scanning?
1. brain (+head and neck) 2. liver 3. rectum and anus 4. kidneys 5. bladder 6. prostate 7. ovaries (+cervix, vagina, uterus) 8. muscoskeletal

PoD topics (34 decks)

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