Imaging in cancer Flashcards by Doyin O

What imaging methods can be used to diagnose and stage cancer

Plain radiographs
Barium studies
CT
MRI
PET

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What is barium sulphate

A radio-opaque contrast used for outlining the gastro-intestinal tract

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How does barium sulphate in barium studies work

The high atomic number of barium absorbs more x-ray photons than surrounding tissue

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What colour does barium appear on radiographs

White

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What does a barium swallow and meal show

Oesophagus
Stomach
Duodenum

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What does a barium follow-through (small bowel study) show

Small bowel

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What does a barium enema show

Large bowel

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How does a patient prepare for a barium meal and follow-through

Fast for 4-6 hours

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How does a patient prepare for a barium enema

Low residue diet for 48 hours

Bowel cleansing with picolax

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What is a CT scan

When X-Rays produce a digitay image of a slice of tissue, normally in an axial plane, using computing to create the image

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What type of cross sectional imaging is used for the initial diagnosis and staging of cancer

CT
MRI
PET

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What can CT, MRI and PET also be used to identify

Response to treatment
Evaluation of mass after treatment
Complications of treatment
Concerns for replase

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What is a hounsfield unit

Attenuation values of voxels are expressed as a CT number which relates the attenuation value to that of water
Ranges from +3000 (bone) to -1000 (air).

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Can CT images be reconstructed

Yes

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What type of CT contrast agents are there

Oral

Intravenous

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What is an oral CT contrast agent

A dilute iodine based contrast (gastrografin) which can be given to outline the gastrointestinal tract

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What is an intravenous CT contrast agent

An iodine based contrast (omnipaque) inject into the veins to show blood vessels or the vascularity of different tissues

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How can imaging help in diagnosis and staging

It shows the: 
Position of the tumour
Depth of penetration of the tumour
Relationship to adjacent structures
Involvement of regional lymph nodes
Presence of distant metastases

What types of tumours do CT scans help diagnose

Lung tumours
Pancreatic tumour
Renal tumours 
Adrenal tumours
Retroperitoneal tumours
Brain tumours

How do CT scans help stage cancers

They assess the local spread (e.g. lymph nodes, adjacent organs) and assess the distant spread (e.g. liver, lung, bone or brain metastases)

What type of cancers are imaged using MRI’s

Brain
Spinal cord
Head and Neck
Liver
Rectum and anal
Kidney
Bladder
Prostate
Ovary
Cervix, vagina, vulva
Uterus
Lymphoma - CNS/MSK
Musculoskeletal

How can CT scans monitor cancer

By making 2D measurement

What do CT scans monitor in cancer

Response to treatment
Relapse
Progression of disease

How many mSv is a patient exposed to from a chest CT

How many mSv is a patient exposed to from an abdomen CT

How many mSv is a patient exposed to from a pelivs CT

What is 10 mSv equivalent to

500 return flights from Manchester to Malaga | 4 years in Aberdeen

What does the ALARA stand for

As low as reasonably achievable

What is the ALARA principle

It ensures whether the examination is necessary | There must be adequate clinical information for appropriate protocol and repeat examinations should be avoid

What does CT stand for

Computed tomograph

What does MRI stand for

Magnetic resonance imaging

How does an MRI scan work

Human body made up of various elements such as: hydrogen, oxygen, phosphorous etc. The strong magnetic field aligns the protons (H+) in the body in one direction A radiofrequency pulse will displace protons The images are created by displaying the time taken for protons to ‘relax’ back to the original alignment

State the indications for an MRI scan

``` The excellent bone soft tissue detail If the vessels can be seen Brain, spine and musculoskeletal studies Abdomen and pelvis studies Cardiac imaging ```

What are the contraindications of an MRI scan

It is claustrophobic and noisy The motion artefact It cannot image patients with pacemakers, aneurysm clips etc.

Name a MRI specific contrast agent

Gadolinium DTPA

What is gadolinium DTPA

An intravenous contrast medium that causes changes in the local magnetic field, so alters the tissue signal

Name 3 NHS screening programmes available

Breast Bowel Cervical

What are the WHO principles of screening

- Condition should be an important health problem - There should be a latent stage of the disease - There should be a test or examination for the conditions - Test should be acceptable to the population There should be treatment for the condition - Facilities for diagnosis and treatment should be avaliable

Which NHS screening programmes involve imaging

Breast Ovarian Lung cancer

What type of screening is used for breast cancer

Mammography

What type of screening is used for ovarian cancer

TVUS (research)

What type of screening is used for lung cancer

Spiral CT (research)

What are the advantages of screening

Detects disease at an early stage where treatment can alter outcome Test causes no harm Test has high sensitivity and specificty Benefits the individual and the population

What are the disadvantages to screening

Cost | Exposure to radiation