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Radiographic Procedures And Pathology. Prep Course 1 > Module 17: Reproductive Radiography > Flashcards

Module 17: Reproductive Radiography Flashcards

1
Q

HYSTEROSALPINGOGRAM. HSPG

INDICATIONS

A
  • Determine the size and shape and position of the uterus and Fallopian tubes
  • To demonstrate lesions such as polyps and tumour masses
  • To investigate the patent of the Fallopian tubes in cases of sterility and infertility
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2
Q

HYSTEROSALPINGOGRAM. HSPG

CONTRAINDICATIONS

A
  • Pregnancy,
  • suspected ectopic pregnancy
  • Acute infection of the vagina or cervix
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3
Q

HYSTEROSALPINGOGRAM. HSPG

CONTRAST MEDIA

A

Water soluble iodinated contrast

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4
Q

HYSTEROSALPINGOGRAM. HSPG

PREPARATION

A

1 Administration of non gas forming laxative on the preceding evening

2- Cleansing enemy until the rectum flow is clear

3- Withhold the preceding meal

4- Explain the procedure to the patient

5- Schedule appointment 10 days following the onset of menstruation ( the endometrium is least congested and it’s a few days before ovulation hence no danger of radiating a fertilised ovum )

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5
Q

HYSTEROSALPINGOGRAM. HSPG

PROCEDURE

A
  • Patient bladder empty prior examination to prevent pressure displacement by the bladder
  • Patient supine in LITHOTOMY position
  • Vaginal canal is irrigated and perineal area is cleaned
  • With vaginal speculum in position, the physician inserts a uterine cannula thru the cervical canal
  • A water soluble contrast medium is introduced via the cannula into the uterine cavity from where it will flow through the patent Fallopian tubes and spill into the peritoneal cavity
  • CR 5cm above the symphysis pubis ( AP, obliques, Lateral )
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6
Q

MAMMOGRAPHY SCREENING

A
  • Performed on an asymptomatic patients
  • Goal is to detect breast cancer when still small
  • Early detection improves patients chances for successful treatments
  • Recommended every one to two years for women over 40
  • 2 projections done CC and MLO
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7
Q

DIAGNOSTIC MAMMOGRAPHY

A
  • Performed on patients that have clinical signs of breast disease or an abnormality was found during screening mammography
  • Specific projections are obtained to rule out cancer such as =

magnification

Spot compression

Medio lateral

LATEROMEDIAL etc

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8
Q

BREAST CANCER RISK FACTORS

A

AGE

  • Incidence increases with age

FAMILY HISTORY

  • A women whose daughter, sister, or mother developed breast cancer, especially at an early age, is at a higher risk

HORMONAL HISTORY

  • Women with early menses ( before 12)
  • Women with late menopause ( after 52 )
  • No children

PERSONAL HISTORY

  • If a women had breast cancer in one breast she is 3or 4 times more likely to develop breast cancer in the opposite breast
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9
Q

COMPRESSION VIEW

A
  • A critical component in breast imaging

- It is controlled by the radiographer, use as much compression as the patient can tolerate

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10
Q

COMPRESSION VIEW

FUNCTION

A
  • Decrease thickness of the breast, better visualisation of anatomy and abnormalities
  • Reduce overlapping normal shadows,which can appear as suspicious lesions
  • Allow the use of a lower x ray dose, thinner breast tissue
  • Immobilise the breast
  • Reduce scatter which leads to poor quality
  • Brings the breast as close to the IR as possible
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11
Q

COMPRESSION view

PROCEDURE

A
  • Review previous images for positioning, compression and exposure factors
  • Explain procedure to patient
  • Instruct patient to remove jewellery, deodorant or powder that may cause artefacts on the image
  • Obtain patient history
  • Note locations of scars, palpable mass, moles, warts
  • Explain why you need additional images to the patient and that they do not necessarily indicate a potential problem
  • Place a Radiopaque marker on the nipple
  • When ever possible, the mobile tissues should be moved towards the fixed tissues
  • Between exams, use disinfectant to clean the equipment
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12
Q

CC PROJECTION

A
  • IR Height is determined by lifting the breast to achieve a 90 deg angle to the chest wall
  • IR at the level of the infra mammary crease at its upper limits
  • Breast pulled forward onto the IR with the nipple in profile
  • The arm on the side of interest is relaxed with the shoulder back out of the way
  • Head turned away from the side being examined
  • Inform patient that compression will be applied
  • Bring compression paddle into contact with the breast while sliding the hand towards the nipple
  • Wrinkles and folds on the breast should be smoothed out and compression applied until taut

Check the medial and lateral aspects of the breast for adequate compression

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13
Q

CC PROJECTION

STRUCTURES DEMONSTRATED

A
  • Entire breast including central, subareolar, medial breast
  • The pectoral muscle is included in approximately 30% of all CC projections
  • Nipple in profile
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14
Q

POSTERIOR NIPPLE LINE

MEASURE,ENT

A

PNL measurement on the CC must be within 1cm of the depth of PNL on MLO projection

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15
Q

MLO PROJECTION

A
  • Degree of obliquity should be between 30-60 deg depending on the patients body habitus
  • IR parallel with the upper 1 third of the pectoral muscle of the affected side
  • Top of IR must be at the level of the axilla
  • Affected arm elevated over the corner of the IR and rest the hand on the hand grip
  • With your thumb and fingers, gently lift breast up, out and away from the chest wall. The nipple should be in profile
  • Slowly apply compression with breast held away from chest wall and up to prevent sagging
  • upper edge of the compression device must rest under the clavicle
  • Lower edge must include the inframammary fold
  • Wrinkles and folds on the breast should be smoothed out
  • Have patient gently retract opposite breast with opposite hand if necessary to prevent superimposition
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16
Q

MLO PROJECTION

STRUCTURES DEMONSTRATED

A
  • Entire breast tissue, emphasis on the lateral aspect and axillary tail
  • Inferior aspect of the pectoral muscle extending to the PNL or below
  • Pectoral muscle showing anterior con exits to ensure a relaxed shoulder and axilla
  • Inframammary fold must be seen and breast must not be drooping
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17
Q

SPOT COMPRESSION

A
  • Defines lesions or area with compression
  • Separates overlying parenchyma
  • Better visualisation of small lesions located in the posterior breast
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18
Q

MAGNIFICATION

A
  • The smallest focal spot is used 0,1mm ( because of the large OID, this decreases geometric unsharpness )
  • Demonstrates margins of lesion and microcalcifications
  • Magnifies the area of interest with improved detail
  • Determines the characteristics of microcalcifications and the margins of suspected lesions
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19
Q

BREAST CANCER

A
  • There are various forms depending on the cells involved
  • Tumours may develop in the ducts or lobes of the breast
  • DUCTAL CARCINOMA INSITU- within the milk ducts
  • LOBULAR CARCINOMA INSITU- within lobules of breast
  • INVASIVE DUCTALCARCINOMA- from milk ducts then spreads to surrounding tissue
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20
Q

BREAST CANCER

CLINICAL SIGNS

A
  • May be asymptomatic in early stages
  • Palpable lump in breast or under the arm
  • Nipple discharge
  • Nipple invasion
  • Skin dimpling
  • Change is breast side or shape
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21
Q

BREAST CANCER

IMAGING

A
  • Mammography
  • US
  • MRI
22
Q

BREAST CANCER

RADIOGRAPHIC APPEARANCE

A

Mammo

  • Malignancy has poorly defined margins, with speculations radiating from the mass
  • Clustered calcifications are very small and localised to one area of the breast
23
Q

FIBROADENOMA OF THE BREAST

A

Solid, benign tumours that often occurs in women over 30

  • A firm , smooth lump with a well defined shape

Clinical signs

    • Painless
  • Moves easily under the skin

Imaging

  • US
  • Mammography
24
Q

FIBROADENOMA OF THE BREAST

RADIOGRAPHIC APPEARANCE

A

Mammo

  • Well- circumscribed lesion
  • Defined margin

US

  • Determines a mass as either solid or cystic
25
Q

FIBROCYSTIC BREAST

A
  • Benign condition of the breast
  • Multiple cysts, usually bilateral
  • The cysts will vary in size and amount of fluid with the menstrual cycle
26
Q

FIBROCYSTIC BREAST

Clinical signs

A
  • Lumpy breast tissue
  • Tender, painful breasts

Imaging

  • Mammo
  • Ultrasound
27
Q

FIBROCYSTIC BREAST

RADIOGRAPHIC APPEARANCE

A

Mammogram

  • Smooth, well circumscribed mass with no invasion of surrounding tissue

US

  • Determines a mass as either solid of cystic
28
Q

CERVICAL CARCINOMA

A

Neoplasm of the cervix

  • Asymptomatic until the advanced stages
  • Pap smear screening detects precancerous cells and then removed
  • Human papilloma Virus infection is a factor in the development of Ca Cervix

Vaccinations are now available to young girls

29
Q

CERVICAL CARCINOMA

Clinical signs

A
  • Asymptomatic in the early stages
  • Vaginal bleeding
  • Pain during intercourse
  • Vaginal discharge
30
Q

CERVICAL CARCINOMA

IMAGING

A
  • CT
  • General Radiography
  • US
  • MRi
31
Q

CERVICAL CARCINOMA

RADIOGRAPHIC APPEARANCE

A

CT

  • Compression of the urinary bladder by the enlarged cervix
  • Hydronephrosis maybe evident on CT images due to urethral obstruction from neoplasms

General RADIOGRAPHY

  • Chest x ray to rule out metastasis to the lungs
32
Q

LEIOMYOMAS

UTERINE FIBROID

A

Benign solid mass of the uterus, developed from an over growth of the uterine smooth muscle tissue

    • Most common benign lesions in females
  • Growth is stipulated by estrogen
  • Often calcified
33
Q

LEIOMYOMAS

UTERINE FIBROID CLINICAL SIGNS

A
  • Heavy bleeding during menstruation
  • Bleeding between menstrual cycles
  • Pelvic pain due to pressure on surrounding structures
34
Q

LEIOMYOMAS

UTERINE FIBROID IMAGING

A
  • KUB
  • IVU
  • Ultrasound
35
Q

LEIOMYOMAS

UTERINE FIBROID

RADIOGRAPHIC APPEARANCE

A

KUB

  • Mottled, popcorn calcifications
  • May occupy the pelvis or project up into the abdomen

IVU

  • Compress the superior surface ( fundus) of the urinary bladder
36
Q

ADENOCARCINOMA OF THE PROSTATE GLAND

A
  • Second most common malignancy in males over 50
  • Often discovered during a rectal exam, ( hard irregular nodule will be palpated on the prostate )
  • An elevated serum PSA (prostate specific antigen ) indicates a prostate abnormality
  • Most common metastasis is bone ( pelvis , spine femur disease ribs)
37
Q

ADENOCARCINOMA OF THE PROSTATE GLAND

CLINICAL SIGNS

A
  • Asymptomatic during the early stages
  • Urinary tract obstruction due to compression on the urethra
  • Dysuria
  • Inability to urinate
  • Urgency to urinate
  • Hematuria
38
Q

ADENOCARCINOMA OF THE PROSTATE GLAND

Imaging

A
  • General RADIOGRAPHY
  • IVU
  • CT
  • US
  • NM
39
Q

ADENOCARCINOMA OF THE PROSTATE GLAND

RADIOGRAPHIC APPEARANCE

A

IVU

  • A carcinoma of the prostate elevates the bladder floor
  • The impression on the bladder floor is irregular

US

  • Preferred modality in detecting prostatic neoplasms

CT and NM

  • Modalities used during staging and identification of metastases
40
Q

BENIGN PROSTATIC HYPERPLASIA

A

Enlarged prostate in males over 50

  • The increased growth causes compression of the urethra
41
Q

BENIGN PROSTATIC HYPERPLASIA

CLINICAL SIGNS

A
  • Urinating 2 or more times a night
  • Dribbling after urinating
  • Weak urine stream
  • Urinary retention
42
Q

BENIGN PROSTATIC HYPERPLASIA

IMAGING

A

IVU often with the post voiding imaging

43
Q

BENIGN PROSTATIC HYPERPLASIA

RADIOGRAPHIC APPEARANCE

A

IVU

  • A smooth filing defect caused by the elevation of the bladder floor
  • Distal fish hook appearance of the distal ureters
  • Bilateral ureter dilation due to obstruction below the bladder
  • Post void imaging May demonstrate poor emptying of the urinary bladder
44
Q

FALLOPIAN TUBES PATNCY

A
  • One cause of infertility in women, is blocked Fallopian tubes
  • May be unilateral or bilateral blockage
  • Blockage May be caused by pelvic inflammatory disease
45
Q

FALLOPIAN TUBES PATNCY

Clinical signs

A
  • Asymptomatic

- Difficulty in conceiving

46
Q

FALLOPIAN TUBES PATNCY

Imaging

A

Hysterosalpingiogram :

Iodinated contrast media is administered into the uterus, patent tubes fill with contrast and spill into the peritoneal cavity

47
Q

FALLOPIAN TUBES PATNCY

RADIOGRAPHIC appearance

A

Blocked Fallopian tubes will not demonstrate contrast spilling into the peritoneal cavity

48
Q

PELVIC INFLAMMATORY DISEASE

A

An infection of the upper genital tract ( above the cervix )

  • PIDis the most common and serious complication of sexually transmitted diseases aside from AIDS among women
49
Q

PELVIC INFLAMMATORY DISEASE

CLINICAL SIGNS

A
  • Fever
  • Vaginal discharge or bleeding
  • Pelvic pain
  • Can scar the Fallopian tubes, ovaries, lead to ectopic pregnancies, infertility , chronic pelvic pain
50
Q

PELVIC INFLAMMATORY DISEASE

Imaging

A

US

51
Q

ECTOPIC PREGNANCY

A

Implantation of the fertilised ovum in the cellophane tubes

  • This occasionally happens , most common region is the Fallopian tubes
  • A potential life threatening condition
52
Q

ECTOPIC PREGNANCY

CLINICAL SIGNS AND IMAGING

A

Clinical signs

  • Abdo pain

Imaging

US

Radiographic Procedures And Pathology. Prep Course 1 (18 decks)

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