Imagining in cancer IA % +

Question 1

Barium studies

Answer 1

• Barium sulphate is a radio-opaque contrast (impenetrable to X-rays)
• used for outlining the gastro-intestinal tract.
• high atomic number of barium absorbs more x-ray photons than surrounding tissues so it appears white

Question 2

Why/when are medical imaging used

Answer 2

• Determine Initial diagnosis and staging of disease
• Monitoring response to treatment
• Evaluation of residual mass after treatment
• Recognition of complications of treatment
• When there is concern for disease relapse

Question 3

How are Barium enema done

Answer 3

• Patient in left lateral position with tube in rectum
• Barium runs into descending colon to splenic flexure
• Turn patient onto right side and let barium run out
• Inflate bowel with air
• Column of contrast pushed forward to caecum by air
• Image in different planes

Note on patient preparation:

• Barium meal and follow-through - fast for 4-6 hours.
• Barium enema - low residue diet for 48 hours and bowel cleansing with Picolax.

Question 4

Describe Computed tomography

Answer 4

• In this form of computer-assisted radiography, an x-ray beam traces an arc at multiple angles around a section of the body. The resulting transverse section of the body, called a CT scan, is shown on a video monitor.
• Visualizes soft tissues and organs with much more detail than conventional radiographs. Differing tissue densities show up as various shades of gray. Multiple scans can be assembled to build 3D views of structures
• Whole-body CT scanning typically targets the torso and appears to provide the most benefit in screening for lung cancers, coronary artery disease, and kidney cancers.

Question 5

Hounsfield Unit

Answer 5

• 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)

Question 6

CT contrast agents

Answer 6

• Oral - dilute iodine based contrast (gastrografin) can be given to outline the gastrointestinal tract (rarely used now)
• Intravenous - iodine based contrast (Omnipaque) injected into the veins to demonstrate blood vessels or the vascularity of different tissues
• Occasionally allergic and anaphylactic reactions with IV contrast occur.

Question 7

Diagnosis and staging of image

Answer 7

• Position of tumour
• Depth of penetration of tumour
• Relationship to adjacent structures
• Involvement of regional lymph nodes
• Presence of distant metastases

Question 8

ALARA Principle for minimizing radiation exposure

Answer 8

• As Low As Reasonably Achievable
• Ensure whether examination is necessary
• Adequate clinical information is essential for appropriate protocol
• Avoid repeat examinations

Question 9

Descibe Magnetic Resonance Imaging

Answer 9

• The body is exposed to a high-energy magnetic field, which causes protons in body fluids and tissues to arrange themselves in relation to the field. Then a pulse of radio waves “reads” these ion patterns, and a color-coded image is assembled on a video monitor. The result is a 2D/3D blueprint of cellular chemistry.

Question 10

MRI pros

Answer 10

• differentiating between normal and abnormal tissues.
• Used to detect tumors and artery-clogging fatty plaques;
• reveal brain abnormalities;
• measure bloodflow
• detect a variety of musculoskeletal, liver, and kidney disorders.

Question 11

MRI Cons

Answer 11

• Bones aren’t seen clearly
• Can’t be used on patients with metal in their bodies e.g patients with pacemakers, aneurysm clips
• Claustrophobic and noisy
• motion artefact

Question 12

MRI contrast agents

Answer 12

• Gadolinium DTPA is an intravenous contrast medium which causes changes in local magnetic field and so alters the tissue signal.
• Also Vascular lesions and some tumours can be more easily seen.

Question 13

WHO principles of screening

Answer 13

• The 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 condition.
• The test should be acceptable to the population
• There should be a treatment for the condition.
• Facilities for diagnosis and treatment should be available.

Question 14

Screening criterias

Answer 14

• Test should detect disease at an early stage, where treatment can alter outcome
• Test should be harmless
• Test should have high sensitivity and specificity
• Benefit must outweigh cost

Question 15

CT use

Answer 15

• Visualizes soft tissues and organs with much more detail
• Differing tissue densities show up as various shades of gray.
• Multiple scans can be assembled to build 3D views of structures
• good for screening in lung cancers, coronary artery disease, and kidney cancers