Module 17: Reproductive Radiography Flashcards
HYSTEROSALPINGOGRAM. HSPG
INDICATIONS
- 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
HYSTEROSALPINGOGRAM. HSPG
CONTRAINDICATIONS
- Pregnancy,
- suspected ectopic pregnancy
- Acute infection of the vagina or cervix
HYSTEROSALPINGOGRAM. HSPG
CONTRAST MEDIA
Water soluble iodinated contrast
HYSTEROSALPINGOGRAM. HSPG
PREPARATION
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 )
HYSTEROSALPINGOGRAM. HSPG
PROCEDURE
- 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 )
MAMMOGRAPHY SCREENING
- 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
DIAGNOSTIC MAMMOGRAPHY
- 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
BREAST CANCER RISK FACTORS
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
COMPRESSION VIEW
- A critical component in breast imaging
- It is controlled by the radiographer, use as much compression as the patient can tolerate
COMPRESSION VIEW
FUNCTION
- 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
COMPRESSION view
PROCEDURE
- 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
CC PROJECTION
- 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
CC PROJECTION
STRUCTURES DEMONSTRATED
- Entire breast including central, subareolar, medial breast
- The pectoral muscle is included in approximately 30% of all CC projections
- Nipple in profile
POSTERIOR NIPPLE LINE
MEASURE,ENT
PNL measurement on the CC must be within 1cm of the depth of PNL on MLO projection
MLO PROJECTION
- 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
MLO PROJECTION
STRUCTURES DEMONSTRATED
- 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
SPOT COMPRESSION
- Defines lesions or area with compression
- Separates overlying parenchyma
- Better visualisation of small lesions located in the posterior breast
MAGNIFICATION
- 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
BREAST CANCER
- 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
BREAST CANCER
CLINICAL SIGNS
- 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
BREAST CANCER
IMAGING
- Mammography
- US
- MRI
BREAST CANCER
RADIOGRAPHIC APPEARANCE
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
FIBROADENOMA OF THE BREAST
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
FIBROADENOMA OF THE BREAST
RADIOGRAPHIC APPEARANCE
Mammo
- Well- circumscribed lesion
- Defined margin
US
- Determines a mass as either solid or cystic
FIBROCYSTIC BREAST
- Benign condition of the breast
- Multiple cysts, usually bilateral
- The cysts will vary in size and amount of fluid with the menstrual cycle
FIBROCYSTIC BREAST
Clinical signs
- Lumpy breast tissue
- Tender, painful breasts
Imaging
- Mammo
- Ultrasound
FIBROCYSTIC BREAST
RADIOGRAPHIC APPEARANCE
Mammogram
- Smooth, well circumscribed mass with no invasion of surrounding tissue
US
- Determines a mass as either solid of cystic
CERVICAL CARCINOMA
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
CERVICAL CARCINOMA
Clinical signs
- Asymptomatic in the early stages
- Vaginal bleeding
- Pain during intercourse
- Vaginal discharge
CERVICAL CARCINOMA
IMAGING
- CT
- General Radiography
- US
- MRi
CERVICAL CARCINOMA
RADIOGRAPHIC APPEARANCE
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
LEIOMYOMAS
UTERINE FIBROID
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
LEIOMYOMAS
UTERINE FIBROID CLINICAL SIGNS
- Heavy bleeding during menstruation
- Bleeding between menstrual cycles
- Pelvic pain due to pressure on surrounding structures
LEIOMYOMAS
UTERINE FIBROID IMAGING
- KUB
- IVU
- Ultrasound
LEIOMYOMAS
UTERINE FIBROID
RADIOGRAPHIC APPEARANCE
KUB
- Mottled, popcorn calcifications
- May occupy the pelvis or project up into the abdomen
IVU
- Compress the superior surface ( fundus) of the urinary bladder
ADENOCARCINOMA OF THE PROSTATE GLAND
- 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)
ADENOCARCINOMA OF THE PROSTATE GLAND
CLINICAL SIGNS
- Asymptomatic during the early stages
- Urinary tract obstruction due to compression on the urethra
- Dysuria
- Inability to urinate
- Urgency to urinate
- Hematuria
ADENOCARCINOMA OF THE PROSTATE GLAND
Imaging
- General RADIOGRAPHY
- IVU
- CT
- US
- NM
ADENOCARCINOMA OF THE PROSTATE GLAND
RADIOGRAPHIC APPEARANCE
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
BENIGN PROSTATIC HYPERPLASIA
Enlarged prostate in males over 50
- The increased growth causes compression of the urethra
BENIGN PROSTATIC HYPERPLASIA
CLINICAL SIGNS
- Urinating 2 or more times a night
- Dribbling after urinating
- Weak urine stream
- Urinary retention
BENIGN PROSTATIC HYPERPLASIA
IMAGING
IVU often with the post voiding imaging
BENIGN PROSTATIC HYPERPLASIA
RADIOGRAPHIC APPEARANCE
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
FALLOPIAN TUBES PATNCY
- One cause of infertility in women, is blocked Fallopian tubes
- May be unilateral or bilateral blockage
- Blockage May be caused by pelvic inflammatory disease
FALLOPIAN TUBES PATNCY
Clinical signs
- Asymptomatic
- Difficulty in conceiving
FALLOPIAN TUBES PATNCY
Imaging
Hysterosalpingiogram :
Iodinated contrast media is administered into the uterus, patent tubes fill with contrast and spill into the peritoneal cavity
FALLOPIAN TUBES PATNCY
RADIOGRAPHIC appearance
Blocked Fallopian tubes will not demonstrate contrast spilling into the peritoneal cavity
PELVIC INFLAMMATORY DISEASE
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
PELVIC INFLAMMATORY DISEASE
CLINICAL SIGNS
- Fever
- Vaginal discharge or bleeding
- Pelvic pain
- Can scar the Fallopian tubes, ovaries, lead to ectopic pregnancies, infertility , chronic pelvic pain
PELVIC INFLAMMATORY DISEASE
Imaging
US
ECTOPIC PREGNANCY
Implantation of the fertilised ovum in the cellophane tubes
- This occasionally happens , most common region is the Fallopian tubes
- A potential life threatening condition
ECTOPIC PREGNANCY
CLINICAL SIGNS AND IMAGING
Clinical signs
- Abdo pain
Imaging
US
