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Medical Conditions 1 > Medical Imagining > Flashcards

Medical Imagining Flashcards

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USMLE® Step 1 flashcards
1
Q

When is imaging not needed?

A
  • when the image will not change the treatment
  • when there is no treatment available
  • when the patient will not consent to the treatment
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2
Q

When is imaging needed?

A

there are different scales and rules used to determine a patient’s need for imaging
- Canadian C-spine rule
- Ottawa ankle index
- Ottawa knee index
- nation emergency X-ray utilization study low risk rule

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3
Q

What are some factors for decision making according to the American college of radiology appropriateness criteria?

A
  • age
  • individual risk facttors
  • trauma presence/absence: physical appearance
  • mechanism of injury
  • neurological status/deficits
  • prior surgery
  • pain provocation/reduction of physical functional tests
  • other imaging results
  • weight bearing ability
  • tenderness to palpation
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4
Q

Radiography

A

X-rays
- produce analog or digital image
- ionizing radiation (what can cause cancer)
- what to keep it to ALARA (As Low As Reasonably Available)

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5
Q

What are some factors to consider when keeping the radiation of an X-ray ALARA

A
  • intensity of radiation
  • number and types of images (most cases need 2)
  • distance from beam
  • patient shielding
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6
Q

X-Rays: How can they are affect the body and how are the images produced?

A
  • can ionize matter/change cellular function
  • can disrupt cellular processes
  • can be used to produce an image through attenuation
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7
Q

Attenuation

A
  • Occurs as X-rays passes through the body
  • reduction in number of x-ray photons in beam
  • occurs as photons interact with matter
  • the photons will scatter which is dependent on density of tissue
  • photoelectric absorption
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8
Q

Attenuation radio density of tissues: rank from least dense to most dense

A
  1. air
  2. fat
  3. water
  4. bone
  5. metal
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9
Q

Other shades of imaging: contrast images
- positive vs negative contrast

A
  • Contrast images: something is ingrested or injected to show certain tissue
  • Eg: barium
  • makes soft tissue more visible on radiograph
  • positive contrast media,show up/lights up
  • negative contrast such as air shows up black
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10
Q

Other shades: metal

A
  • surgical metal
  • accidents, trauma (GSW)
  • the thickness affects the radio-density such as edges of bones are not as dense as the middle
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11
Q

What are the different views that can be used for radiography

A
  • anterior-posterior (enters anterior exits posterior)
  • posterior-anterior (enters posterior/exits anterior)
  • lateral (left or right)
  • 2 oblique views
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12
Q

describe the lateral views

A
  • left lateral: enters right and exits left
  • right lateral: enters left and exits right
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13
Q

what are some considerations when looking at a radiography

A
  • distortion
  • exposure
  • contrast
  • motion
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14
Q

Osteoporosis in an image

A
  • edges have high density
  • grey on the inside
  • decrease in bone density means they are more likely to sustain a fracture
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15
Q

Ankylosing Spondylitis

A
  • fusing of the spine with inflammation
  • an inflammatory process that caused the spine to fuse
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16
Q

CT/CAT scan

A
  • computed axial tomography
  • cross-sections slices
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17
Q

CT uses

A
  • subtle and or complex fractures
  • degenerative changes in bone and joints
  • serious trauma (can image bone and soft tissue)
  • spinal stenosis (impingement of spinal nerves)
  • intervertebral disk
  • loose body in joints
  • bony alignments in any place
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18
Q

CT imaging
- acquired?
- density
- slices thickness

A
  • images can be acquired in coronal, sagittal or axial plane
  • image density can be selected to emphasize soft tissue or bone
  • thickness of slices can allow for more detailed views of structures
19
Q

CT vs MRI

A
  • CT is faster
  • less incidence of claustrophobia
  • less expensive than MRI
  • MRI is better at looking at differences in soft tissue
  • MRI does not use radiation
20
Q

MRI: How it works?

A
  • uses protons in hydrogen atoms in the patients body and an electromagnet to produce an image
  • hydrogen found in body in
    ~free water in body fluids (CSF)
    ~ water bound to large molecules like proteins
    ~hydrogen atoms in fat
21
Q

What are the types of MRI imaging

A
  • T1
  • T2
  • others: FLAIR, SPIN, STIR
22
Q

T1 MRI

A
  • shortest acquisition time
  • can see fat, acute hemorrhage will appear brightest (highest signal intensity)
23
Q

T2 MRI

A
  • longer acquisition time
  • can see free water with inflammation, tumors, synovial fluid, CSF will appear brightest
24
Q

Other types of MRI: FLAIR, SPIN, STIR

A
  • used for specific diagonostic purpose eg CNS and brain injury
25
Q

Clinical uses for MRI

A
  • excellent for soft tissue assessment
  • musculoskeletal and sports injury
  • can assess integrity of tendons, ligaments, menisci
  • bone marrow changes, eg. neoplasm, stress fracture, avascular necrosis
  • disc herniation, nerve root impingement
26
Q

Limitations to MRI

A
  • time: takes a long time 40 min. to an hour
  • expensive
  • availability is limited
  • contraindications: any ferrous metal in body risks injury or death
  • precautions: pacemaker, claustrophobia
27
Q

Iodine-containing contrast medium

A
  • used for X-ray and CT to better view soft tissues
  • Oral, IV, injection or other
28
Q
  • cautions: for Iodine-containing contrast medium
A
  • patients with reduced kidney function (contrast-induced nephropathy/kidney disease)
  • patients with iodine allergy (mild to severe)
  • elimination is through the kidney and can damage it
29
Q

Gadolinium-based contrast

A
  • 1 in 3 MRI use contrast
  • given through IV
30
Q

cautions for Gadolinium-based contrast

A
  • patients with reduced kidney function (nephrogenic systems fibrosis)
  • less risk of allergic reaction than iodine
  • elimination in about 24 hours
31
Q

Other medications that can be used with
1. CT or MRI
2. CT with contrast

A
  1. medication to reduce anxiety or claustrophobia
  2. steroid if previous allergic reaction
32
Q

Ultrasound (MSKUS)

A
  • can be used instead of MRI to assess soft tissue
  • uses sound waves
  • other healthcare workers can do it
  • can vary in time
33
Q

Ultrasound advantages

A
  • portability, ease of use, lower cost
  • no known contraindications
  • movement is not a concern
  • quick comparison to opposite side
  • high resolution
  • can follow a structure from beginning to end
  • shows internal architecture of muscle tendon, and ligaments better than an MRI
34
Q

Doppler US

A
  • evaluates blood flow
  • vascular for blockage
  • DVT diagnosis
  • cardiovascular
  • joint capsule
35
Q

Abdominal US

A
  • used to assesinternal organs
  • complete abdominal US also includes
    1. kidney
    2. spleen
    3. bladder
    4. abdominal blood vessels
36
Q
  1. Right upper quadrant
  2. right lower quadrant
  3. left upper quadrant
  4. left lower quadrant
A
  1. liver, pancreas, gallbladder, duodenum, right kidney, hepatic flexure
  2. cecum, appendix, right ureter
  3. stomach, spleen, left lobe of liver, left kidney, spleenic flexture
  4. descending colon, sigmoid colon
37
Q

Abdominal ultrasound common conditions

A
  • bladder stones
  • gallstones
  • cholecystitis: gallbladder inflammation
  • enlarge spleen (splenomegaly)
  • pancreatitis
  • cancer (stomach or pancreatic)
  • fatty liver disease
  • abdominal aortic aneurysm
38
Q

Arthrography

A

can identify abnormalities of synovium, ligaments, articular cartilage and joint capsule

39
Q

Myelography

A
  • generally used to look at things with the spine
  • type of X-ray
40
Q

Tomogram

A
  • used before CT
  • X-ray tool that can be moved
41
Q

Nuclear Medicine

A
  • uses a radioactive substance called a tracer
  • the tracer is administered to the patient with injection, inhalation, or ingestion
  • the tracer allows for evaluation of the function of a specific organ
  • image produced using a gamma camera
  • can create static or moving images
    (look at things like how blood is flowing through an organ or the GI tract
42
Q

Nuclear medicine types

A
  • bone scan/bone scintigraphy: looks for areas of hyper function, increased mineral turnover (new bone being laid down)
  • positron emission scan (PET scan) : mostly in neuro
  • single positron emission CT (SPECT): used for detecting small abnormalities in bone, heart, brain, or liver (organs)
43
Q

What is interventional radiology

A
  • epidural steriod injections
  • spinal nerve blocks
  • radiofrequency ablation (heart surgery to get rid of excess tissue)
  • percutaneous needle biopsy (through the skin)
  • vertebroplasty, kypoplasty (plasty means repair - these are postural repairs)

Medical Conditions 1 (16 decks)

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