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Introduction to radiology Flashcards

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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
What is usually the initial imaging technique?
plain films
26
What are some advantages to using plain films?
-cost effective compared to other studies -easy access -quick -good for finding basic emergent findings
27
What are some disadvantages to using plain films?
-difficult to make definitive diagnosis (soft tissue pathology) -need additional studies
28
Who were plain films started by?
Wilhelm Rontegen in 1895
29
What occurs in a plain film?
xray beam passes through the body
30
What is the term used to describe how the beam is weakened and is tissue dependent so densities will appear as different shades?
attenuation
31
In plain films, what color is air/gas?
black or dark gray
32
In plain films, what color is fat?
gray; lighter than air; darker than muscle
33
In plain films, what color is water?
various shades of gray
34
In plain films, what color is mineral?
white
35
In plain films, what color is metal and contrast agents?
bright white
36
What type of attenuation does air have?
low attenuation
37
What type of attenuation does bone/metal have?
high attenuation
38
What are the different positioning for plain films?
AP PA lateral oblique supine upright or standing
39
In plain films, what does positioning affect?
magnification, organ positioning, and blood flow
40
What type of studies are two-dimensional views of 3D structures?
plain films
41
What must plain films always have?
2 views at right angles of each other (orthogonal images)
42
What are the indications of plain films?
-initial imaging technique *bony abnormalities *structural changes (cardiopulmonary changes *screening for cancer and/or other pathologies (pneumonia) *foreign bodies
43
What are the contraindications of plain films?
no defined contraindications
44
What is fluoroscopy associated with?
plain films
45
What is a continuous x-ray imaging that does spot filming or video recording?
fluoroscopy
46
What procedures is a fluoroscopy used in?
-assessing movement of a body part -insertion of an instrument -monitoring movement of a contrast agent
47
What started in the early 1970s and is described as a rotating fan of xray beams through the patient?
CT scan
48
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?
CT scan
49
What is the ability to manipulate images to be able to see things more/better?
"windowing"
50
What measures the density of structures and provides the ability to delineate structures within the defined window?
Windowing - hounsfield units
51
What is the unit used to describe density of structures?
hounsfield units
52
With high HU (hounsfield units), what would you be getting a better look at?
bones - bone windowing
53
What with low HU give you a better look at?
organs such as the lungs
54
What is the attenuation of CT scans?
same as xrays
55
What color is air in a ct scan?
black
56
What color is fat in a ct scan?
dark gray
57
What color is soft tissue in a ct scan?
light gray
58
What color is bone/calcium in a ct scan?
white
59
What color is contrast in a ct scan?
white
60
How should you interpret CT/MRI scans?
as if you are looking at the patient from the foot of the bed
61
What are the different type of CT scanners?
-traditional ct -helical ct -multidetector ct
62
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
traditional
63
What type of CT scanner is this describing: -moves continuously through the gantry at constant speed, decreasing artifact from patient movement -under 1 minute
helical
64
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
multidetector
65
What are the advantages of a CT scan?
-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
What are the disadvantages to CT scans?
-increased radiation exposure -cost, depending on the scan
67
What ways can contrast be taken for CT scans?
IV oral rectal
68
Why would contrast be good to use?
can be used for differentiating solid vs cystic masses and for fluid accumulation (abscesses)
69
What are some examples of CT scans for musculoskeletal use?
-joints that aren't seen well with x-rays (SI joint, vertebral bodies) -intra-articular fractures -bony abnormalities -soft tissue abnormalities
70
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**
MRI
71
Instead of attenuation, MRIs use what?
intensity
72
What color is high signal intensity with MRIs?
white
73
What color is intermediate signal intensity with MRIs?
gray
74
What color is low signal intensity with MRIs?
black
75
When comparing two structures in MRIs, you can use what terms?
-hyperintense -isointense -hypointense
76
What are pulse sequences in MRI terminology?
-refers to how the protons are manipulated -tissue properties determine the pulse sequence
77
What describes how protons interact with surrounding tissue in MRI terminology?
T1
78
What describes how protons interact with each other in MRI terminology?
T2
79
What is the density of protons within a region called in MRI terminology?
proton density
80
What is Fluid attenuated inversion recovery (FLAIR)?
T2 sequence that suppresses the brightness of water
81
What do FLAIR MRIs help differentiate?
abnormalities that obscured by water (CSF, Edema)
82
What is short T1 inversion recovery described as?
-suppresses the brightness of fat
83
What do STIR MRIs get better visualization of?
tumors and inflammation
84
When can't you evaluate STIR images?
when gadolinium contrast is used
85
What type of MRI image is based on the motion of water molecules?
diffusion weighted imaging (DWI)
86
In diffusion water imaging, more water intracellularly is associated with what?
injury/disease
87
In diffusion water imaging, decreased movement is associated with what?
tumor
88
What type of imaging differentiates soft tissue and will display different signal intensities because of tissue pathology?
MRI
89
In T1, fat is ____ and water is _____
bright; dark
90
In T2, fat is ____ and water is ____
dark; bright
91
What is difficult to see on an MRI?
bone
92
What are you seeing instead of calcium in MRIs?
fat in the bone barrow
93
What are the contraindications associated with MRIs?
-implants/metal devices -retained metal objects/foreign bodies -severe claustrophobia -pregnant or breastfeeding (contrast is a category C)
94
What are the advantages of MRIs?
-no radiation -better tissue contrast than CT scan
95
What are the disadvantages of MRIs?
-artifact due to patient moving -longer scan times -expensive -safety concerns: magnet strength -loud, knocking noises during the scan
96
What are MRIs with contrast used to evaluate?
-tumors -inflammation -blood supply -organ/joint features
97
What does gadolinium do for MRIs?
increase intensity
98
What is gadolinium best used for viewing?
T1 weighted images **does not contain iodine
99
What imaging technique uses high frequency, inaudible, sound waves?
ultrasound
100
In ultrasounds, what are images produced by?
the echo phenomenon
101
What is the Echo phenomenon?
-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
An anechoic echogenicity describes what?
no echoes (black)
103
A hyperechoic echogenicity describes what?
strong echoes (white)
104
What is the attenuation of fluid in untrasounds?
black
105
What is the attenuation of bone in ultrasounds?
white
106
What is the attenuation of tissue in ultrasounds?
various shades of gray (depends on density)
107
Fluid is ______ Soft tissues are _______ Bone/air are ______
anechoic hypoechoic hyperechoic
108
What does the doppler effect on ultrasounds analyze?
the returning echo from the motion of blood flow
109
In doppler ultrasounds, what does red/orange colors depict?
blood flow toward the transducer
110
In doppler ultrasounds, what does a blue color depict?
blood flow away from the transducer
111
What are the advantages of ultrasounds?
-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
What are the disadvantages of ultrasounds?
-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
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?
myelogram
114
What other diagnostic imaging uses radionuclide imagine and shows increased uptake such as increased blood flow, increased osteoblastic activity and heightened metabolic activity?
nuclear medicine (bone/PET scan)
115
What is the field of medicine that utilizes medical imaging for minimally invasive procedures?
interventional radiology
116
What has interventional radiology replaced the need for?
open surgeries
117
What are the pros of interventional radiology?
-decreased recovery time -decreased risk of infection and other complications -decreased hospital stays -improved morbidity and mortality
118
What types of procedures can be done in interventional radiology?
-angiography/angioplasty -gastrostomy tubes -stent placement -needle biopsies -IVC filters -catheter insertions -cancer treatments

Radiology (6 decks)

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