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radiology > intro > Flashcards

intro Flashcards

1
Q

black on plain x-ray

less dense and thin

A

radiolucent

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2
Q

white plain x-ray

dense and thick

A

radio-opaque

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3
Q

two words to describe CT

A

low and high attenuation

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4
Q

nuclear lingo

A

low and high uptake

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5
Q

MRI terminology

A

high and low signal

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6
Q

24-hour x-ray interpretation and availability for questions; radiologist reading your x-rays in
real-time but in a different time zone

A

allows radiologist in other locations to read your films

teleradiology

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7
Q

nechoic, hyperechoic, hypoechoic, acoustic shadow

are all terms that refer to what type of imagine

A

Ultrasound (ULA)

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8
Q

view box direction

A

old–>new–> newest

so the new ones would be viewed on your right

don’t forget pts left if your right

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9
Q

most common imaging you are going to order

A

plain film

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10
Q

dense materials are

A

radio-opaque

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11
Q

plain film is good for

A

bone
lung and pleura pathology
foreign bodies
and air filled structures (lung and bowel)

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12
Q

when would you NOT want to use a plain film

A

detail, precise location
solid organs
brain
vasculature detail

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13
Q

five densities of x-rays

A

air, fat, soft tissue, calcium, metal)

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14
Q

plain x-ray CXR indications

A

upper GI complaints (diaphragm)

trauma

procedures/lines (radio-opaque so you can make sure they are in the right place)

admissions: almost everyone admitted to the ED get a chest x-ray

chest pain

respiratory symptoms

fever

chest pain

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15
Q

face/spine x-ray indications

A

face fractures and trauma

soft tissues

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16
Q

abdomen indications for plain film

A

obstructions

foreign bodies

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17
Q

extremities indications for xray

A 
fracture/trauma
foreign bodies
gas, fluid in soft tissue
metabolic Dx
bony tumors
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18
Q

x-ray readings 5 things in order

A 
Verify Name, Date
● Verify Study
● Verify Body Part
● Are the images adequate?
● If there is a question of an abnormality, (compare to previous study or other side and use old films)
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19
Q

what color would fat be in plain films

A

dark-grey (4)

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20
Q

what color would gas be in plain films

A

black (5)

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21
Q

what color would soft tissue/fluid be in plain films

A

light-grey (3)

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22
Q

cone calcification would be what color in plain films

A

nearly white (2)

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23
Q

what color would metal be in plain films

A

white (1)

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24
Q

Air-fluid levels are only seen if

A

Air-fluid levels are only seen if X-ray beam is horizontal (parallel to the floor)

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25
Q

orthogonal view

A

90 degrees view

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26
Q

different views

A

AP (anteroposterior) or PA (posteroanterior)
■ Lateral
■ Oblique
■ Supine, upright, lateral decubitus

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27
Q

when is magnification is the most important

A

CXR

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28
Q

why would you use a lordotic film?

A

Lordotic films will displace clavicles & distort image; useful in assessing upper lobes for TB

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29
Q

how would you know if you’re looking at a lordotic film

A

clavicles are high riding

30
Q

each CT study has multiple images _________, “slices”: scroll through on PACS

A

each study has multiple images (25->100), “slices”: scroll through on PACS

31
Q

CT & MRI images described using plane of orientation

A

CT & MRI images described using plane of orientation (coronal, sagittal, or axial/transverse)

32
Q

why use a contrast like barium in a CT

A

Contrast (barium) adds density (it’s white ), defines structures

33
Q

why would you use a CT w/ contrast

A

adds density and certain things take up contrast

Vasculature (IV)
Tumors (IV)
Abdominal pathology (IV)
Bowel (if swallowed PO)

34
Q

high attenuation in a CT scan refers to what type of material

A

dense

appears white

35
Q

low attenuation on a CT refers to what type

A

dark

less dense material

36
Q

what are the Honsfield units of a hyper or hypo attenuation area

A

Refers to densities

and will tell you what densities are most consistent with what type of material

37
Q

mantra of Lauri involving CT and contrast

A 
CT
contrast
Creatinine 
no metformin for a day
no metformin for two dasy
38
Q

metformin rules with contrast

A

No Metformin 24hrs before/48hrs after contrast

39
Q

what are the advantages of a CT

A

Readily available
Great for bone detail Great for brain & abdomen
Can detect metallic FB 3D available (vs. 2D conventional x-ray)
Can reformat images for clarity, precision

40
Q

disadvantages of a CT

A

Radiation dose
Ischemic CVA – misses subtle, new ones

Vertebrobasilar system (cerebellum) – not great here

Renal function for contrast

Replacing traditional medicine (Hx and physical)

41
Q

Applies a powerful magnetic field to atoms which realign and release energy; radio wave mapped as image

A

MRI

42
Q

how do we talk about mRI

A

high or low signal
T1: water black

or T2: fat black

weighted

43
Q

Advantages of MRI

A

Non-ionizing radiation No known side effects Excellent for soft tissue Shows vasculature w/o contrast
Definitive study for brain and spine
Titanium, stainless steel OK
Contrast = gadolinium = no renal damage unless GFR <30ml/min
Safe in pregnancy

44
Q

disadvantages of MRI

A

Cost
Not readily available as CT
Claustrophobia (10% failure)
Imaging time, motion artifact

45
Q

Contraindications for MRI

A

Contraindications:

  • Unstable patients
  • Ferrous metal
  • Pacemaker
46
Q

why would you use a MRI

A

Ligament/tendon injuries (soft tissue)
Spine/spinal cord injury or lesion (tumor, abscess) Brainstem/cerebellar pathology Intracranial masses/tumors – detail, staging CVA(non-contrastCT1s t thenMRI) Multiple sclerosis, Encephalitis Ortho: occult fractures (esp hip, scaphoid), avascular necrosis, tumors, osteomyelitis, stress fractures
Biliary tract - MRCP – gallstone pancreatitis, cholangitis Pregnant pt

47
Q

what does weighting refer to

A

how the image is presented w/ respect to pulse sequence paramters that affect proton relaxation time

48
Q

T1 water s

A

black (low signal)

ventricles/CSF

49
Q

T2 CSF would be

A

white

50
Q

advantages of ULS

A 
Cheap, safe, portable, instant
No radiation
Real time guidance for procedures
Color doppler use for vasculature
Serial exams at bedside Peds – can avoid radiation
51
Q

ULS terminology

A 
Hyperechoic  or   Echogenic (bright/white) Hypoechoic or A  nechoic (dark/black)
Acoustic shadow  (band of reduced echoes behind an echo-dense object)
52
Q

disadvantages of ULS

A

Operator-dependent

53
Q

indications of ULS

A

Trauma (FAST exam) Cardiac (Echo)/Lung Obstetrics & Gynecology Aorta
Biliary System, Kidneys, Bladder, Appendix
IV’s/Central Lines
DVT
Abscess, Foreign Bodies Soft Tissue, Eye
Nerve Blocks
Lumbar Puncture

54
Q

indications for nuclear studies

A

PET scan – cancer dx/staging
Bone scan – cancer dx/staging Thyroid scintigraphy – dx and tx of thyroid goiter, nodules, hyperthyroidism, cancer
V/Q scan – PE
HIDA scan – choledocholithiasis

Myocardial perfusion scan – cardiac perfusion studies

55
Q

x-rays are attenuated more or less by bone compared to tissue

A

more

more attenuated = more radio opaque

56
Q

dose dependent biological effects become measurable above ________ and a whole body dose of greater than _____ is universally lethal

A

dose dependent biological effects become measurable above 50mSv (millisieverts) and a whole body dose of greater than 10Sv (sieverts) is universally lethal

57
Q

This means that a chest X-ray amounts ________ background radiation and a CT abdomen is equivalent to_____

A

This means that a chest X-ray amounts to 3 days of background radiation and a CT abdomen is equivalent to 4.5 years!

58
Q
  • Measures should be in place to reduce dose to patients and staff is known as
A

optimization

59
Q

Measures to ensure wider regulations are enforced, for example that X-ray machines are correctly installed and used, and that referrals are justified are known as

A

local rules

60
Q

Potential benefit of radiation exposure should outweigh risk. is known as

A

justification

61
Q

‘inverse square law

A

the dose to a given area is quadrupled be halving the distance from the radiation source.

62
Q

how to present during a osce

A
  1. Demonstrate a systematic approach
  2. Describe and summarise the salient abnormalities
  3. Link the abnormalities to the clinical scenario
  4. Suggest appropriate management or further investigations
63
Q

opening line for a osce plain film reading

A

This is a plain CHEST/ABDOMINAL radiograph of PATIENT’S NAME taken on DATE at TIME, it is a PA/AP/SUPINE/MOBILE image, and I note the side marker is correct…’

‘The image is of adequate quality…’ -

64
Q

Although you are unlikely to be given a chest X-ray with poor inspiration how would you evaluate if a CXR was appropriate

A

you should always quickly note if the lungs are hyperexpanded. The quickest way to do this is to see if the hemidiaphragms are flattened, and if you are not sure, then count ribs.

65
Q

what should you do after noting the obvious abnormality

A

after noting the obvious abnormality by saying “the first abnormality to comment on..”

then say I am now examining the image systematically

66
Q

what is the proper evaluation of a CXR systematically

A

The trachea is central…

‘The hilar structures are normal…

The upper, middle and lower zones of the lungs are symmetrical and clear…

The costophrenic angles and hemidiaphragms are well-defined…

The heart size and contours are normal…

I can see no abnormality of the bones or soft tissues…’

67
Q

how to describe Equivocal findings in a OSCE

A

‘I am not sure if the… (anatomical structure)… is abnormal. It appears… (describe the structure)…’

68
Q

how to finish a plain film evaluation on an OSCE

A

‘In summary, this X-ray demonstrates evidence of…
‘These findings are consistent with the clinical suspicion of…’.
‘In this situation I would manage the patient by…’

69
Q

indications of fluroscopy

A

cardiac angiography GI swallowing studies Cystourethrogram Biopsies
Special lumbar punctures Complex vasculature access Removal of foreign bodies

70
Q

cardiac angiography GI

what type of imaging would you want

A

fluroscopy

radiology (13 decks)

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