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Radiology > Introduction to radiology > Flashcards

Introduction to radiology Flashcards

1
Q

When choosing imaging modalities, what should you look at?

A

-indications
-patient status
-reliability
-risks and benefits
-need for multiple studies

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2
Q

What determines what modality to start with?

A

patient status

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3
Q

What type of practice are these associated with?
-imaging usually ordered during patient visit
-patient goes to imaging center/scheduled for diagnostic test

A

family practice

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4
Q

What type of practice are these associated with?
-most places have x-rays
-not common to have other imaging equipment

A

urgent care

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5
Q

What type of practice are these associated with?
-has x-rays, CT scan, ultrasounds (bedside; duplex)
-do not routinely order MRI scan emergently

A

Emergency departments

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6
Q

What type of practice are these associated with?
-may have own equipment due to heavy use

A

specialty settings

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7
Q

What are the different imaging ordering components?

A

-patient name and demographics
-diagnosis
-reason (not just the patient’s symptoms; provide some history)
-may need to provide laboratory findings (pregnancy status, kidney function (contrast)
-location

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8
Q

What are the different types of forms used for imaging orders?

A

EMR
Forms

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9
Q

What are the components of imaging ordering that fall under location?

A

-laterality (right, left, bilateral)
-anatomic area (right shoulder vs. right humerus; abdomen vs. abdomen and pelvis)

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10
Q

What must you know for radiology?

A

anatomy and anatomic landmarks

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11
Q

What assists with determining the location of a lesion?

A

contrast agents

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12
Q

What are contrast agents used to visualize?

A

-spinal cord
-blood vessels
-GI tract
-ureters
-bladder

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13
Q

How are contrast agents delivered?

A

-orally
-intravenously
-rectally (not as common)

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14
Q

What can contrast agents reduce?

A

kidney function

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15
Q

What must you assess/know before ordering imaging with contrast?

A

kidney function

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16
Q

What should you do when you order imaging with contrast?

A

-order BUN/Creatine when ordering CT scan
-consider pregnancy test

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17
Q

Contrast reactions are deemed what when using contrast agents?

A

low risk

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18
Q

What does the approach to imaging interpretation consist of?

A

-Pt identification (name, age, gender)
-date of study (compare to old studies when available)
-know what imaging modality you are evaluating
**plain film vs. CT with or w/o contrast
**orientation (AP, lateral, oblique)
**laterality (right, left bilateral(
**with or without contrast (CT w contrast in coronal, frontal, or axial view)

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19
Q

What do you took at when considering technical quality of imaging interpretation?

A

-appropriate position of the body
-quality
-contrast
-over or under exposure

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20
Q

What should your systematic approach to imaging modality consist of?

A

-need to understand normal anatomy (anatomic landmarks)
-know common anatomic variants
-avoid naming the abnormality as a specific disease
**realize what is abnormal, then think about disease pathologies that can cause the abnormality

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21
Q

What should you note about imaging interpretation and when you will provide the interpretation?

A

it is setting dependent
-primary care
-ED/UC/Specialty setting

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22
Q

In a primary care office, how do providers receive/interpret images?

A

-provider receives reports from radiologist
-could also review the images if they have access to EMR

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23
Q

In an ED/UC/specialty center, how do providers receive/interpret images?

A

-provider may be required to read own films with opportunity to request read by radiologist
-providers in many specialty settings will read their own images and compare to radiologist impression

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24
Q

What is the most ordered imaging modality?

A

plain films

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25
Q

What is usually the initial imaging technique?

A

plain films

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26
Q

What are some advantages to using plain films?

A

-cost effective compared to other studies
-easy access
-quick
-good for finding basic emergent findings

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27
Q

What are some disadvantages to using plain films?

A

-difficult to make definitive diagnosis (soft tissue pathology)
-need additional studies

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28
Q

Who were plain films started by?

A

Wilhelm Rontegen in 1895

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29
Q

What occurs in a plain film?

A

xray beam passes through the body

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30
Q

What is the term used to describe how the beam is weakened and is tissue dependent so densities will appear as different shades?

A

attenuation

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31
Q

In plain films, what color is air/gas?

A

black or dark gray

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32
Q

In plain films, what color is fat?

A

gray; lighter than air; darker than muscle

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33
Q

In plain films, what color is water?

A

various shades of gray

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34
Q

In plain films, what color is mineral?

A

white

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35
Q

In plain films, what color is metal and contrast agents?

A

bright white

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36
Q

What type of attenuation does air have?

A

low attenuation

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37
Q

What type of attenuation does bone/metal have?

A

high attenuation

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38
Q

What are the different positioning for plain films?

A

AP
PA
lateral
oblique
supine
upright or standing

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39
Q

In plain films, what does positioning affect?

A

magnification, organ positioning, and blood flow

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40
Q

What type of studies are two-dimensional views of 3D structures?

A

plain films

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41
Q

What must plain films always have?

A

2 views at right angles of each other (orthogonal images)

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42
Q

What are the indications of plain films?

A

-initial imaging technique
*bony abnormalities
*structural changes (cardiopulmonary changes
*screening for cancer and/or other pathologies (pneumonia)
*foreign bodies

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43
Q

What are the contraindications of plain films?

A

no defined contraindications

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44
Q

What is fluoroscopy associated with?

A

plain films

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45
Q

What is a continuous x-ray imaging that does spot filming or video recording?

A

fluoroscopy

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46
Q

What procedures is a fluoroscopy used in?

A

-assessing movement of a body part
-insertion of an instrument
-monitoring movement of a contrast agent

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47
Q

What started in the early 1970s and is described as a rotating fan of xray beams through the patient?

A

CT scan

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48
Q

In what type of imaging are the transmission points calculated by a computer and produces an image and also has the ability to make “windows” and 3D reconstructions?

A

CT scan

49
Q

What is the ability to manipulate images to be able to see things more/better?

A

“windowing”

50
Q

What measures the density of structures and provides the ability to delineate structures within the defined window?

A

Windowing - hounsfield units

51
Q

What is the unit used to describe density of structures?

A

hounsfield units

52
Q

With high HU (hounsfield units), what would you be getting a better look at?

A

bones - bone windowing

53
Q

What with low HU give you a better look at?

A

organs such as the lungs

54
Q

What is the attenuation of CT scans?

A

same as xrays

55
Q

What color is air in a ct scan?

A

black

56
Q

What color is fat in a ct scan?

A

dark gray

57
Q

What color is soft tissue in a ct scan?

A

light gray

58
Q

What color is bone/calcium in a ct scan?

A

white

59
Q

What color is contrast in a ct scan?

A

white

60
Q

How should you interpret CT/MRI scans?

A

as if you are looking at the patient from the foot of the bed

61
Q

What are the different type of CT scanners?

A

-traditional ct
-helical ct
-multidetector ct

62
Q

What type of CT scanner is this describing:
-patient is moved into position, gantry stops, image is taken
-repeated for all sequences
-up to 5-10 minutes

A

traditional

63
Q

What type of CT scanner is this describing:
-moves continuously through the gantry at constant speed, decreasing artifact from patient movement
-under 1 minute

A

helical

64
Q

What type of CT scanner is this describing:
-uses helical technology, but adds multiple detector rows
-8 times faster, improves resolution, and provides detailed images

A

multidetector

65
Q

What are the advantages of a CT scan?

A

-more effective medical management
-evaluate structures not visualized on plain films (internal structures; diarthrodial joints)
-visualize multiple structures at once
-quick scan (10 minutes)
-noninvasive

66
Q

What are the disadvantages to CT scans?

A

-increased radiation exposure
-cost, depending on the scan

67
Q

What ways can contrast be taken for CT scans?

A

IV
oral
rectal

68
Q

Why would contrast be good to use?

A

can be used for differentiating solid vs cystic masses and for fluid accumulation (abscesses)

69
Q

What are some examples of CT scans for musculoskeletal use?

A

-joints that aren’t seen well with x-rays (SI joint, vertebral bodies)
-intra-articular fractures
-bony abnormalities
-soft tissue abnormalities

70
Q

What uses magnetic field to align hydrogen atoms, and then a second magnet field is applied, and radiofrequency pulses pass through the nuclei to create the image?
captured images are then analyzed by a computer and images are generated

A

MRI

71
Q

Instead of attenuation, MRIs use what?

A

intensity

72
Q

What color is high signal intensity with MRIs?

A

white

73
Q

What color is intermediate signal intensity with MRIs?

A

gray

74
Q

What color is low signal intensity with MRIs?

A

black

75
Q

When comparing two structures in MRIs, you can use what terms?

A

-hyperintense
-isointense
-hypointense

76
Q

What are pulse sequences in MRI terminology?

A

-refers to how the protons are manipulated
-tissue properties determine the pulse sequence

77
Q

What describes how protons interact with surrounding tissue in MRI terminology?

A

T1

78
Q

What describes how protons interact with each other in MRI terminology?

A

T2

79
Q

What is the density of protons within a region called in MRI terminology?

A

proton density

80
Q

What is Fluid attenuated inversion recovery (FLAIR)?

A

T2 sequence that suppresses the brightness of water

81
Q

What do FLAIR MRIs help differentiate?

A

abnormalities that obscured by water (CSF, Edema)

82
Q

What is short T1 inversion recovery described as?

A

-suppresses the brightness of fat

83
Q

What do STIR MRIs get better visualization of?

A

tumors and inflammation

84
Q

When can’t you evaluate STIR images?

A

when gadolinium contrast is used

85
Q

What type of MRI image is based on the motion of water molecules?

A

diffusion weighted imaging (DWI)

86
Q

In diffusion water imaging, more water intracellularly is associated with what?

A

injury/disease

87
Q

In diffusion water imaging, decreased movement is associated with what?

A

tumor

88
Q

What type of imaging differentiates soft tissue and will display different signal intensities because of tissue pathology?

A

MRI

89
Q

In T1, fat is ____ and water is _____

A

bright; dark

90
Q

In T2, fat is ____ and water is ____

A

dark; bright

91
Q

What is difficult to see on an MRI?

A

bone

92
Q

What are you seeing instead of calcium in MRIs?

A

fat in the bone barrow

93
Q

What are the contraindications associated with MRIs?

A

-implants/metal devices
-retained metal objects/foreign bodies
-severe claustrophobia
-pregnant or breastfeeding (contrast is a category C)

94
Q

What are the advantages of MRIs?

A

-no radiation
-better tissue contrast than CT scan

95
Q

What are the disadvantages of MRIs?

A

-artifact due to patient moving
-longer scan times
-expensive
-safety concerns: magnet strength
-loud, knocking noises during the scan

96
Q

What are MRIs with contrast used to evaluate?

A

-tumors
-inflammation
-blood supply
-organ/joint features

97
Q

What does gadolinium do for MRIs?

A

increase intensity

98
Q

What is gadolinium best used for viewing?

A

T1 weighted images
**does not contain iodine

99
Q

What imaging technique uses high frequency, inaudible, sound waves?

A

ultrasound

100
Q

In ultrasounds, what are images produced by?

A

the echo phenomenon

101
Q

What is the Echo phenomenon?

A

-waves travel through tissue and each has different acoustic properties
-return velocity are collected by piezoelectric crystals in transducer
-images displayed in gray scale

102
Q

An anechoic echogenicity describes what?

A

no echoes (black)

103
Q

A hyperechoic echogenicity describes what?

A

strong echoes (white)

104
Q

What is the attenuation of fluid in untrasounds?

A

black

105
Q

What is the attenuation of bone in ultrasounds?

A

white

106
Q

What is the attenuation of tissue in ultrasounds?

A

various shades of gray (depends on density)

107
Q

Fluid is ______
Soft tissues are _______
Bone/air are ______

A

anechoic
hypoechoic
hyperechoic

108
Q

What does the doppler effect on ultrasounds analyze?

A

the returning echo from the motion of blood flow

109
Q

In doppler ultrasounds, what does red/orange colors depict?

A

blood flow toward the transducer

110
Q

In doppler ultrasounds, what does a blue color depict?

A

blood flow away from the transducer

111
Q

What are the advantages of ultrasounds?

A

-no radiation
-readily available/portability
-less cost than other imaging modalities
-used at bedside (real time images)
-doppler evaluation (blood flow)
-not affected by metallic objects

112
Q

What are the disadvantages of ultrasounds?

A

-operator error
-ability to evaluate tissue with high impedance (organs obscured by overlying bowel gas)
-possible injury to thermal heating
-could be limited by body habitus

113
Q

What other diagnostic imaging is not used as much but is used to evaluate for disc herniation and spinal cord compression from a tumor or trauma?

A

myelogram

114
Q

What other diagnostic imaging uses radionuclide imagine and shows increased uptake such as increased blood flow, increased osteoblastic activity and heightened metabolic activity?

A

nuclear medicine (bone/PET scan)

115
Q

What is the field of medicine that utilizes medical imaging for minimally invasive procedures?

A

interventional radiology

116
Q

What has interventional radiology replaced the need for?

A

open surgeries

117
Q

What are the pros of interventional radiology?

A

-decreased recovery time
-decreased risk of infection and other complications
-decreased hospital stays
-improved morbidity and mortality

118
Q

What types of procedures can be done in interventional radiology?

A

-angiography/angioplasty
-gastrostomy tubes
-stent placement
-needle biopsies
-IVC filters
-catheter insertions
-cancer treatments

Radiology (6 decks)

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