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Radiology > Intro to Radiology > Flashcards

Intro to Radiology Flashcards

1
Q

Who discovered radiology

A
  • 1895 William Roentgen
  • Experimenting with electricity passing thru glass vacuum tube
  • Invisible energy caused florescence and passed through objects
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2
Q

Imaging Modalities

A
  • X-ray (plain films)
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Ultrasound (ULS)
  • Nuclear Medicine
  • Fluoroscopy (joints, angiography, swallow studies)
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3
Q

Terminology: Plain X-Rays

A
  • Radiolucent
  • Radiopaque
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4
Q

Terminology: CT

A
  • Low attenuation
  • High attenuation
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5
Q

Terminology: Nuclear

A
  • Low uptake
  • High uptake
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6
Q

Terminology: MRI

A
  • High signal
  • Low signal
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7
Q

Terminology: Ultrasound

A

Anechoic, hyperechoic, hypoechoic, acoustic shadow

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8
Q

PACS - modern radiology

A

-picture archiving and communication system

  • Computerized replaces hardcopy
  • Instant access, old films archived
  • Teleradiology
  • Images to CD for patient/referral
  • Hardcopies
  • Rural/remote and international
  • Back-up when electricity fails
  • View box: old->new viewed left to right
  • Orientation: pt’s right on your left*
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9
Q

Plain x-rays are good for:

A
  • Bone
  • Lung and pleura pathology
  • Foreign bodies
  • Air filled structures (lung, bowel)
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10
Q

Plain x-rays are not good for:

A
  • Detail, precise location
  • Solid organs
  • Brain
  • Vasculature detail
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11
Q

Indications for CXR

A

– Respiratory symptoms

– Chest pain

– Fever

– Upper GI complaints

– Procedures/lines

– Trauma

– Admission

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12
Q

Indications for Face/Spine X-ray

A

-PLAIN X-RAY IS NOT THE INITIAL TEST IN THIS CASE

– Fractures/trauma

– Soft tissues: neck

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13
Q

Indications for abdomen X-ray

A

-PLAIN X-RAY IS NOT THE INITIAL TEST IN THIS CASE

– Obstruction

– Foreign Bodies

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14
Q

Indications for extremities X-ray

A

– Fracture/trauma

– Foreign bodies

– Gas, fluid in soft tissue

– Metabolic Dx

– Bony tumors

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15
Q

Density on plain x-rays

A
  • Dense, thick - radiopaque = white – Absorbs more xray
  • Less dense, thin - radiolucent = grey to black – absorbs less xray
  • Shades of grey essential to identify structures, position, overlap
  • Rads techs can adjust for pt size – Can change wavelength for density – Can change milliamps and time of exposure
  • Easy to change w/ PACS
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16
Q

How are air-fluid levels seen

A

-ONLY IF X-RAY BEAM IS HORIZONTAL TO THE FLOOR

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17
Q

When do objects appear larger on x-ray

A
  • If beam source is closer to the patient/object
  • If object is further from imaging surface
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18
Q

How to determine if the x-ray is taken in the lordotic position

A

-CLAVICLES they should be between the 3rd and 4th rib, but they will be riding high

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19
Q

Computed Tomography (CT)

A
  • 1972: Godfrey Hounsfield
  • Initially took 9 hours to produce image
  • 1976: whole body scanners “tomos” and “graphein” Prototype t=4 min (each “slice”)
  • 2006 t=0.5 sec • 2014 t=0.3 sec: multirow detector, less radiation
20
Q

Orientation of patient - CT

A

looking at a CT, the pts right is on your left, and the left is on your right. The anterior is top and posterior is bottom

21
Q

Density in CT scans

A
  • Referred to as attenuation
  • High attenuation = dense – White on image
  • Low attenuation = less dense – Shades of grey to black
  • Qualified as Hounsfield units by radiologist
22
Q

CT contrast studies

A
  • Adds density (it’s white), defines structures
  • IV, PO: Barium
  • Contras: renal insufficiency (creatinine >1.5), allergy
  • Indications – IV: vasculature, tumors, abdominal pathology – Oral: bowel
  • No Metformin 24hrs before/48hrs after contrast
23
Q

CT indications: head/brain

A
  • Injuries/trauma, CVA, Altered Mental Status, New Sz, etc
24
Q

CT indications: chest

A

– Lung abnormalities

• infection, tumor, effusion, etc – Pulmonary embolus – Aortic issues

25
Q

CT indications: abdomen

A

– Acute infections/inflammation – Obstruction (bowel, stone) – Cancer staging

26
Q

CT indications: extremities/face/spine

A

– Complex fractures – Infection

27
Q

CT advantages

A
  • Readily available
  • Great for bone detail
  • Great for brain and abdomen
  • Can be used with metallic FB
  • 3-dimensional versus 2-D conventional xray – Can reformat images for clarity, precision
28
Q

CT disadvantages

A
  • Radiation dose
  • Ischemic CVA – misses subtle, new ones
  • Vertebrobasilar system (cerebellum) – not great here
  • Renal function for contrast
  • Replacing traditional medicine
29
Q

MRI

A
  • 1st proposed in 1976, in use by ‘84
  • Applies a powerful magnetic field to atoms which realign and release energy
  • Radio wave mapped as image
  • High or low “signal”
  • T1 or T2 weighted – basic
  • Contrast = gadolinium
  • Will likely replace CT in your career
30
Q

MRI indications

A
  • Ligament/Tendon injury (soft tissue)
  • Spine/spinal cord injury or lesion (tumor, abscess)
  • Brainstem/cerebellar pathology
  • Intracranial masses, tumors – detail, staging
  • CVA – non-con CT first, MRI follows CT
  • Multiple Sclerosis, Encephalitis
  • Ortho: occult fx’s (esp hip, scaphoid), avascular necrosis, tumors, osteomyelitis, stress fractures
  • Biliary tract - MRCP – gallstone pancreatitis, cholangitis
  • Pregnant pt
31
Q

MRI advantages

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
32
Q

MRI disadvantages

A
  • Cost
  • Not readily available as CT
  • Claustrophobia (10% failure)
  • Imaging time, motion artifact
  • Contraindications – Unstable patient – Ferrous metal – Pacemaker
33
Q

MRI: T1 or T2 weighted

A
  • “Weighting” is how the image is presented w/ respect to pulse sequence parameters that affect proton relaxation time
  • T1 weighted – water is black (low signal), fat is bright (high signal)
  • T2 weighted – water is bright, fat is black
  • Contrast bright white on both
  • Brain/spinal cord MRI –> look at CSF
34
Q

MRI in orthopedics

A

-Widely used

  • Multiple soft tissue structures, bone, joint spaces, synovial fluid
  • Can reformat with “fat suppression”
  • Review with radiologist
35
Q

Ultrasound

A
  • Uses high frequency sound waves
  • Echoes are produced
  • Does not use ionizing radiation
  • Unique nomenclature
  • Has completely revolutionized Emergency Medicine
36
Q

Ultrasound advantages

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
37
Q

Ultrasound disadvantages

A

-operator dependent

38
Q

Ultrasound indications

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
  • Etc, Etc…
39
Q

Nuclear Studies

A
  • Patients given nuclear agent with short half life
  • Agent has affinity for certain organs (thyroid, bone, lung, heart, tumor)
  • Scanner picks up static tracer concentration or dynamic rate of tracer through blood flow
  • High or low “uptake”
  • Equipment and operation highly specific, interpreted by radiologist
  • Difficult to obtain at odd hours
40
Q

Nuclear Medicine Studies

A
  • PET scan
  • Bone scan
  • Thyroid scintigrophy
  • V/Q scan
  • HIDA scan (gallbladder)
  • Myocardial Perfusion Scan
  • Cancer diagnosis/staging
  • Dx and treatment of thyroid goiter, nodules, hyperthyroidism, cancer
  • Pulmonary Embolus
  • Choledocholithiasis
  • Cardiac Perfusion Studies
41
Q

PET scan

A
  • Positron Emission Tomography
  • Radioactive material IV
  • Pt is briefly a “source” of radiation
  • Scan detects positron uptake:
  • “Lights up” – Cancer/tumors – Coronary heart disease – Seizure disorder – Alzheimerʼs
42
Q

V/Q scan

A
  • Dx of pulmonary embolus if CT w/ con not possible
  • Assessment of regional lung function
  • V= ventilation
  • P=perfusion
  • Alternative to CT, less sensitive, used less
43
Q

Fluoroscopy

A
  • Live images in motion with continuous x-ray
  • Can follow fluid thru hollow spaces to check integrity
  • Used to monitor path of needles, injections or capture items/structures
  • Real-time guidance for procedures/surgery
44
Q

Examples of Fluoroscopy

A
  • Ortho joint injections, surgical guidance
  • Cardiac angiography
  • GI swallowing studies
  • Cystourethrogram
  • Special lumbar punctures
  • Complex vascular access
  • Removal foreign bodies
45
Q

Angiography

A
  • Study of blood vessels
  • Heart, brain, etc
  • Stenosis, aneurysms
  • IV contrast
  • Conventional fluoroscopy
  • CT or MRI

Radiology (4 decks)

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