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Intercalation > Pattern Recognition > Flashcards

Pattern Recognition Flashcards

1
Q

What are the 4 components of a medical image?

A

Equipment Patient Signal Receptors Signal Processing

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2
Q

Describe equipment as a component of a medical image.

A

It is dealt with in relation to the patient It relates to: - positioning of equipment - equipment used - MRI specific or surface coils

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3
Q

Describe signal processing as a component of a medical image

A

It tended to via a computer using specific algorithms Can be chemical in terms of film processing

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4
Q

Describe signal receptors as a component of a medical image

A

Change between modalities - Transducers - Image recording plate - Film / Screen combination - Radioreceiver - PMTs

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5
Q

Describe the patient as a component of a medical image

A

Need to understand the anatomy and physiology Positioning of the patient

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6
Q

What needs to be understood to interpret an image?

A
  • Interaction of the source with various tissue types - Affect of beam geometry - Affect of patient position on structures - Anatomical structures (localisation, physiology and manifestation of disease)
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7
Q

What is the effect of beam divergence? How is it reduced?

A

Image magnification Gives a geometric unsharpness Reduce by placing the recording medium as close to the object

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8
Q

Why is a chest X-ray taken PA?

A

Allows for assessment of heart size It reduces unsharpness and magnification It reduces the effect of breast tissue If AP then the scapula can be projected into the lung field

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9
Q

How is a chest X-ray taken?

A

PA (posterio-anteriorly) Remove the scapula out of the image view

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10
Q

How does shade and colour alter perception of images?

A

Shade helps to identify structures The mind fills the gap to create the perception of depth 10% of colour interpretation is governed by context not wavelength

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11
Q

What are the problems associated with radiography?

A

3D representation in a 2D image Summation of shadows Standardisation in positioning is vital to identify positioning and location

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12
Q

What is the benefit of standardisation of positioning?

A

Allows you to identify the position and the location You become familiar with the orientation - familiar frame of reference

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13
Q

How are hands X-rays usually acquired?

A

Dorsi-palmar Need to label right and left

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14
Q

What is a reason for altering from a standard projection?

A

Makes it more comfortable for the patient If the patient is less likely to move

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15
Q

What are the 4 different types of contrast?

A

Subject Recording medium/system - Image Objective Subjective

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16
Q

What is the difference between subject and image contrast?

A

Subject contrast is the differences between X-ray intensities emerging from the patient Image contrast is the differences recorded in the radiographic image

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17
Q

What is the difference between subjective and objective contrast?

A

Subjective - dependent on the eye of the observer, varies from person to person Objective - actual differences in densities or black and white

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18
Q

How can subject contrast be changed?

A

Altering differences in attenuation using contrast agent - Barium, iodide, gadolinium

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19
Q

What are examples of contrast agent?

A

Barium Iodide Gadolinium

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20
Q

What are examples of contrast agent?

A

Barium Iodide Gadolinium

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21
Q

Why is it important to get the patient, X-ray detector and beam source parallel?

A

Need to get a truly representative image Otherwise can get: foreshortening or elongation

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22
Q

What is foreshortening in an X-ray image?

A

The image appears squashed Happens when the patient leans forward

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23
Q

What is elongation in an X-ray image?

A

If the detector is angled you get a stretched/elongated image Can be used advantageously in the scaphoid

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24
Q

Where can beam geometry be applied usefully?

A
  • PA chest radiography - Sacroiliac joints demonstration - Aid to identifying patient positioning
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25
Q

What are the identification points when assessing a radiographic image?

A
  • Check patient ID - Time & date of examination - Check correct anatomical markers and appropriate legends - Facility name
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26
Q

What are the identification points when assessing a radiographic image?

A
  • Check patient ID - Time & date of examination - Check correct anatomical markers and appropriate legends - Facility name
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27
Q

What anatomical features do you need to check when assessing a radiographic image?

A
  • Check all relevant anatomy is included in the projection - Are all anatomical features accurately displayed? - Sharp definition of all cortical outlines and/or soft tissue - Protocols (differ between facilities) - Trace bony outline (disruption = pathology) - Compare both sides and projections
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28
Q

What are the points to check in terms of image quality in a radiographic image?

A
  • Is there adequate contrast and density displayed? - Is there adequate penetration? - Is there any signs of unsharpness? - Is there any evidence of collimation? - Are there any artefacts present?
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29
Q

What is the sign that indicates adequate penetration in a chest X-ray?

A

Should be able to see the 4 thoracic vertebrae through the heart. If this is not visible, could be pathology or inadequate exposure.

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30
Q

What are the categories for artefacts?

A

Anatomical e.g. hair External e.g. clothing, pins, hearing aids Internal e.g. swallowed items Equipment/imaging related e.g. dust

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31
Q

What are the problems with X-ray interpretation that can lead to misdiagnosis?

A

Overlapping structures Projecting what you expect to see onto the image (e.g. if the patient is in pain, a soft tissue line can be viewed as a fracture)

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32
Q

What are the requirements for interpretation of an image?

A
  • Understand what is in the image - Understand what is in the patient - Understand what was conducted - Be aware of the limitations of the procedure
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33
Q

What are the requirements for interpretation of an image?

A
  • Understand what is in the image - Understand what is in the patient - Understand what was conducted - Be aware of the limitations of the procedure
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34
Q

What is pattern recognition?

A

It is an information reduction process. The assignment of visual logical patterns to classes based on features of these patterns and their relationship

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35
Q

What is clinical judgement?

A

It is the interpretation of X, being a real example of Y or support the conclusion reached

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36
Q

What is clinical judgement?

A

It is the interpretation of X, being a real example of Y or support the conclusion reached

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37
Q

What is the function of an X-ray examination?

A
  • Accurate localisation of fracture and determination of number of fragments - Indicate the degree and direction of displacement - Provide evidence of pre-existing disease - May demonstrate a foreign body - May show indication of nature of injury (This can be linked to any imaging modality)
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38
Q

What are the limitations of an X-ray examination?

A
  1. Contrast resolution 2. Spatial resolution 3. Sensitivity of the system - Need 30-50% bone loss to detect osteoporosis
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39
Q

What modalities can be used to detect osteoporosis?

A
  • X-ray (poor) due to low sensitivity - DEXA - Radionuclide (very sensitive but not specific)
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40
Q

What are the points on a checklist for reviewing diagnostic image appearances?

A
  • Size and shape of structure - Position of structures - Thickness of structures - Mineralisation - Trabeculation of cancellous bone - Vascular patterns - Contour of structure (smooth/sharp) - Look for symmetry - Joint space, size, shape, normal? - Alignment/articulation - Soft tissue assessment - Changes with development - Correct numbers of bones - Relationship with other structures
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41
Q

What are the points on a checklist for reviewing diagnostic image appearances?

A
  • Size and shape of structure - Position of structures - Thickness of structures - Mineralisation - Trabeculation of cancellous bone - Vascular patterns - Contour of structure (smooth/sharp) - Look for symmetry - Joint space, size, shape, normal? - Alignment/articulation - Soft tissue assessment - Changes with development - Correct numbers of bones - Relationship with other structures
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42
Q

What are the starting points to interpreting an image?

A
  • Examine general appearance of the bone - Trace the contour of each bone for irregularities - Examine joint space - Examine soft tissue (can provide indirect evidence of a fracture)
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43
Q

Why is it important to examine soft tissue in an X-ray?

A

Can provide indirect evidence of a fracture.

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44
Q

Why is it important to examine soft tissue in an X-ray?

A

Can provide indirect evidence of a fracture.

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45
Q

What are the 2 ossification centres and what are they responsible for?

A

Primary - controls width of bone Secondary - controls the length of bone

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46
Q

What is an additive disease?

A

Abnormal condition leading to an increase in fluid or bone. Fluid has the effect of distending tissue, which increases the thickness.

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47
Q

What are the results of having an additive disease?

A
  • Bone has a higher than average atomic number (compared to normal bone) - Excessive bone growth or the replacement of cartilaginous tissue with bone - Increase n the amount of calcium present in the bone - Bone becomes denser in structure - Bone is more radio-opaque - Can be focal or general
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48
Q

What are the most common additive disease?

A
  • Acromegaly - Paget’s disease - Osteoarthritis - Osteochondroma - Osteopetrosis
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49
Q

What is a destructive disease?

A

Abnormal condition leading to an increase in air or fat OR a decrease in normal body fluid or bone

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50
Q

What are the results of having a destructive disease?

A
  • Demineralisation of bone or an invasive destruction of bone tissue - Decrease in the amount of calcium in the bone - Bone becomes less dense in structure - Bone more radiolucent - Can be general or focal
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51
Q

What are the common destructive diseases?

A
  • Osteoporosis - Rheumatoid arthritis - Osteomalacia - Exostosis - Osteomyelitis - Gout - Hyperparathyroidism - Ewings tumour
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52
Q

What are the 3 types of bone abnormalities?

A
  1. Opacity - increased radiographic density e..g overlapping bone fragments 2. Radiolucency - decreased radiographic density e.g. fracture line 3. Distortion/displacement of normal structures e.g. - Bump/step/gap in cortex - buckle or bowing - collapse (vertebrae) - subluxation/dislocation - soft tissue swelling
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53
Q

What are the 3 types of bone abnormalities?

A
  1. Opacity - increased radiographic density e..g overlapping bone fragments 2. Radiolucency - decreased radiographic density e.g. fracture line 3. Distortion/displacement of normal structures e.g. - Bump/step/gap in cortex - buckle or bowing - collapse (vertebrae) - subluxation/dislocation - soft tissue swelling
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54
Q

What is a Jones/avulsion fracture?

A

Tendon pulls off part of the bone it is attached to

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55
Q

What is a Jones/avulsion fracture?

A

Tendon pulls off part of the bone it is attached to

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56
Q

What are the points to note on a pelvis X-ray?

A
  1. Sacro-iliac joints should be equal in width 2. Sacral foramina should not be disrupted 3. Superior surface of the symphysis pubis should be aligned (should be approx 5mm) 4. Acetabular regions should be compared for variation
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57
Q

What does a widening in the sacro-iliac joint represent?

A

Fracture of the main ring

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58
Q

What is the usual distance between the superior surface of the symphysis pubis?

A

5mm

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59
Q

What are the 2 rings of the pelvis?

A
  1. Main pelvic ring 2. 2 Smaller rings formed from pubic and ischial bones
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60
Q

What are the frequent pelvic fractures?

A

Acetabular Sacral Coccygeal

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61
Q

What should be checked when looking at an X-ray of the cervical spine?

A
  • Lines should be smooth and unbroken - Check vertebral alignment: - Along the anterior margins of vertebral bodies - Along the posterior margins of vertebral bodies - Along anterior bases of spinous processes (may be slight step at C2) - Vertebral bodies below C2 have a uniform, oblong shape - Intervertebral discs should be of equal height - The relationship between the anterior aspect of the odontoid peg and posterior aspect of the anterior arch of C1 should be no more than 3mm in adults and 5mm in children
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62
Q

What should be checked when looking at an X-ray of the cervical spine?

A
  • Lines should be smooth and unbroken - Check vertebral alignment: - Along the anterior margins of vertebral bodies - Along the posterior margins of vertebral bodies - Along anterior bases of spinous processes (may be slight step at C2) - Vertebral bodies below C2 have a uniform, oblong shape - Intervertebral discs should be of equal height - The relationship between the anterior aspect of the odontoid peg and posterior aspect of the anterior arch of C1 should be no more than 3mm in adults and 5mm in children - Spinous process should be in a straight line - Distances between spinous processes should be equal - Atlanto-axial distance approximately equal distance - Lateral margins of C1 should align with lateral margins of C2
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63
Q

Describe the normal relationship between C1 and the odontoid peg.

A

The anterior aspect of the odontoid peg and posterior aspect of the anterior arch of C1 should be no more than 3mm in adults and 5mm in children Peg = 1/3 Space = 1/3 Cord = 1/3 Lateral margins of C1 should align with lateral margins of C2

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64
Q

Describe the soft tissue in the cervical spine

A

C1-C4 7mm approximately 30% of the vertebral body C5-C7 22mm approximately 100% of the vertebral body

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65
Q

Describe the soft tissue in the cervical spine

A

C1-C4 7mm approximately 30% of the vertebral body C5-C7 22mm approximately 100% of the vertebral body

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66
Q

What are the 5 lines to consider when assessing facial bones?

A
  • Superior orbital margin - Inferior orbital margin - Inferior zygomatic - Superior mandibular - Inferior mandibular
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67
Q

What are the rules for trauma imaging?

A
  • 2 views or possibly more required - Joints above and below the fracture must be visualised in case they may be involved - Ensure to continue the search even if a fracture is noted - When no fracture is noted, note any changes to the joint - Look for indirect evidence of fractures such as displacement of fat pads - Examine for a foreign body
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68
Q

If a decision cannot be made about a diagnosis based on an image, what should be done?

A
  • Postpone the decision - Get more information - Get further views - Ask a colleague - Use a reference
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69
Q

How can you tell if a chest x-ray is foreshortened?

A

The clavicles appear higher than normal

It alters the shape of the mediastinum

It changes the shapes of the ribs

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70
Q

What condition is shown here?

A

Osteochondroma

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71
Q

What condition is shown here?

What are the notable features?

A

Paget’s disease

Thickened trabecular and cortical bone

The bone is weaker and as a result of it being a weight bearing bone, it bends.

It doesn’t affect the fibular

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72
Q

What condition is shown here?

What are the notable features?

A

Osteoarthritis

  • Reduced Joint space due to erosion of cartilage
  • Joint area more radio-opaque due to bodies protective mechanism (laying down extra bone to protect the joint)
  • Can have (but not present) bony outgrowths/osteophytes
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73
Q

What condition is shown here?

What features can be noted?

A

Rheumatoid arthritis

Z deformity in the thumb

Swan neck deformity in the little finger

Carpal bones, loss of joint spaces / decrease bone density

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74
Q

What pathology can be seen here?

A

Radial head fracture

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75
Q

What pathology can be seen here?

What are the notable features?

A

Fractured Neck of Femur

The left leg is shorter than the left due to the raised greater trochanter

The leg is externally rotated as you can see more of the lesser trochanter

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76
Q

What pathology can be seen here?

What are the notable features?

A

Osteoporosis - vertebral collapse

The bone is thinner resulting in less attenuation of the Xray beam

Only the trabecular bone is degraded so the framing occurs as the cortical bone remains - this gives low contrast

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77
Q

What sign is apparent in this image?

A

Sail sign

It is a soft tissue sign. Due to the increased pressure within the joint, the fat pad is elevated.

It is indicative of a radial head fracture

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78
Q

What can be seen in this image?

A

Bipartite patella - this is a normal variation

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79
Q

What can be seen in the image?

A

Multiple pelvic fractures - the likelihood of multiple fractures is increased due to the circular shape

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80
Q

What pathology can be seen here?

A

Facial fracture

It can be identified as one of the sinuses has filled with blood, indicating a fracture.

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81
Q

What are the 7 stages to Chest X-ray interpretation?

A
  1. Acceptability of the radiograph
  2. Diaphragm, heart and mediastinum
  3. Lung edges
  4. Lung fields and posterior ribs
  5. Anterior ribs & shoulder girdles
  6. Neck and soft tissue
  7. Assess for any tubes/wires/catheters
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82
Q

What should be checked to make sure a chest radiograph is suitable for use?

A
  • Patient ID
  • Date of examination
  • Markers
  • Patient position (standard projection, is the patient erect)
  • Medial clavicles shoud be equidistant from the spinous processes
  • Scapula should be free from the lung field
  • Sufficient phase of respiration (count ribs)
  • Adequate penetration
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83
Q

How do you assess for adequate penetration in a chest X-ray?

A

Should be able to see down to T4 spinous process

Beam should have enough power to display all features

Need to be able to see behind the heart - if not could be a hidden pathology

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84
Q

What is the normal number of ribs seen in a X-ray when erect?

A

8-11

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85
Q

What is the normal number of ribs seen in a X-ray when seated?

A

7-9

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86
Q

In a chest X-ray what must be assessed in terms of technical quality of the image?

A

Projection

Orientation

Rotation

Penetration

Degree of inspiration

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87
Q

CXR: What needs to be assessed in stage 2?

A

Diaphragm, heart and mediastinum

Trace around and assess:

  • heart size and shape
  • mediastinum
  • hilar vessels
  • fissures
  • shape of aortic knuckle
  • Free gas
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88
Q

CXR: Where should you look most closely for free gas?

A

Right hemidiaphragm

Under the pericardium

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89
Q

CXR: How would aortic stenosis present?

A

Increased size in the left ventricle - the heart has to work harder against the resistance of the stenosis

Can cause increase in the size of the ascending aorta and the aortic arch - depends on where the stenosis is

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90
Q

CXR: How would mitral disease present?

A

Increase in the size of the left atrium

Deviated pulmonary trunk

In later stages, the left and right atria can enlarge in addition to a larger left ventricle. Pulmonary trunk enlargement.

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91
Q

CXR: How do you check the mediastinum?

A

Check the shape - is it normal?

Check the edge outline - it should be clear

Some fuzziness is acceptable:

  • at the angles between the heart and diaphragm
  • apices
  • right hilum
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92
Q

CXR: What does fuzziness in the edge of the mediastinum indicate?

A

It could be normal (in expected places)

Can indicate collapse or consolidation

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93
Q

CXR: In a normal image how do the hilar appear?

A

Left should be higher than the right

Difference between them should be less than 2.5cm

Should be concave in appearance

Should have similar densities and shapes

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94
Q

CXR: In a normal image how does the trachea appear?

A

Should be central

Slight deviation to the right at the aortic knuckle

A shift is indicative of mediastinal problems

Spinous processes should be in the centre of the trachea

The white edge on the right should be no larger than 2-3mm on an erect film

Right main bronchus is wider and steeper than the left

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95
Q

CXR: How would a right upper lobe collapse appear?

A

Change in aeration of the right upper lobe - becomes more radio-opaque (whiter)

Trachea pulled slightly to the right

Displacement of horizontal fissure

Hilum displaced

No change in heart border

Minor fissure deflected upwards

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96
Q

CXR: How would a major right upper lobe collapse appear?

A

Right upper lobe is a flat wedge of opacity

Trachea deviated to the right

Aortic arch is tilted to the right

Upper lobe opacity is against the superior mediastinum

Right hilum is drawn upwards

Compensatory overaeration in lower lobes (more radio-lucent)

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97
Q

CXR: What is the normal appearance of the diaphragm?

A

Right is higher than the left

Difference should be less than 3mm

Outline should be smooth

The highest point of the right diaphragm should be in the centre of the right lung field

Highest point on the left is slightly more lateral

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98
Q

CXR: What is the normal appearance of the costophrenic angles?

A

Well defined

Acute angles

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99
Q

CXR: What are the early signs of a left lower lobe collapse?

A

Less heart shadow to the right of the spine

Vague decrease in lucency of the lower left lobe

Preservation of the left hemidiaphragm (slightly elevated medially)

Displacement of the hilum

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100
Q

CXR: What are the signs of a major left lower lobe collapse?

A

Little or no heart shadow at the right of the spine

Medial half of the border fo the left diaphragm is missing

Left lower lobe is a wedge of opacity

Left hilum is depressed

Medial hemidiaphragm is obscured

Upper lobes overaerated

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101
Q

CXR: What are the mediastinal lines and stripes that are visible?

A

Anterior pleural junction line

Posterior pleural junction line

Right paratracheal stripe

Left paratracheal stripe

Aortopulmonary window

Para-aortic stripe

Azygoesophageal stripe

Paravertebral/paraspinal stripe

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102
Q

CXR: Describe the anterior pleural junction line

A

It is a result of parietal and visceral pleura meeting anteromedially

Seen on 40% of frontal chest X-rays

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103
Q

CXR: Describe the posterior pleural junction line

A

Formed by the opposition of pleural surfaces of posteromedial surfaced of upper lobe of lungs

Posterior to the oesophagus

Anterior to T3-T5

Seen on 32% of PA chest X-rays

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104
Q

CXR: Describe the right paratracheal stripe

A

Normal on a frontal chest X-ray

Represents right tracheal wall, adjacent pleural surfaces and any mediastinal fat

Measures less than 4mm (widens in disease)

Appears radio-opaque

Lungs and pleura wrap around trachea

Seen in 97%

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105
Q

CXR: Describe the left paratracheal stripe

A

Formed by the interface of medial pleura surface of the left upper lobe and the left lateral border of trachea.

Less common to see due to aorta/subclavian/common carotid

Seen in 20-30% of PA chest X-rays

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106
Q

CXR: Describe the aortopulmonary window

A

Lies between the aorta and pulmonary vessels

Look to see if the window is obscured

Can be obscured by lymph vessels

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107
Q

CXR: Describe the para-aortic stripe

A

Line that follows the aorta down

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108
Q

CXR: Describe the azygoesophageal stripe

A

Indicates the border of the pleura and fllows the oesophagus and azygous vein

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109
Q

CXR: Describe the paravertebral line

A

Refelection of the lungs around the vertebrae

Only see if there is a pathology - haematoma, osteophytes

RIGHT –> interface of right lung and posterior mediastinal soft tissue (25% of frontal chest Xray)

LEFT –> left lung and left posterior mediastinal tissue, appears darker due to the heart shadow (35% of frontal chest X-rays)

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110
Q

CXR: What should be assessed in step 3?

A

Lung edges

Look for evidence of effusion or pneumothorax

Look for evidence of thickening of tagging of the pleura

Don’t forget to check behind the heart

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111
Q

CXR: What features demonstrate effusion?

A

Blunting of the costo and cario-phrenic angles

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112
Q

CXR: Descibe the hilar vascular markings

A

Hilar vascular markings are smaller in the top half of the X-ray field - this is due to gravity

When the lung field is divided into thirds vertically:

The 1/3 closest to the midline - vascular markings are prominent

The middle 1/3 - vascular markings are visible but are less prominent

The outer 1/3 - vascular markings are fine and difficult to visualise

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113
Q

CXR: What should be assessed in stage 4?

A
  • Compare the right and left lung fields for similar densities
  • Compare zones on both sides
  • Compare vascular markings to surrounding features
  • Any changes in radio-opacity?
  • Check for lung tissue behind the heart
  • Count posterior ribs (DON’T MISS 1ST RIB)
  • Note the hilar shadows
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114
Q

CXR: Normally how many posterior ribs should be visible?

A

9-10

Can vary on each side

Don’t omit the first rib

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115
Q

CXR: What are the lobes and fissures that can be seen?

A

Oblique or major fissure

Minor fissure

Azygous lobe fissure

Azygous lobe (NV)

Superior accessory fissure (NV)

Inferior accessory fissure (NV)

(NV) - normal variant

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116
Q

Which lung is visible in this image? Why?

A

Right

The right diaphragm is higher and is continuous from anterior to posterior and extends all the way from the sternum

The right major fissure has union with the minor

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117
Q

CXR: Which lung is visible in this image?

A

The left diaphragm is lower and it extends to the heart shadow.

Major fissures merge with the ipsilateral diaphragm.

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118
Q

Describe the left minor fissure of the lung

A

It only occurs in 8% of people but can only be seen in 1.6% of chest x-rays

It separates the lingula from the rest of the left upper lobe

Often resembles the right minor fissure

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119
Q

CXR: What is the companion shadow of the 2nd rib?

A

It is a dark shadow in the apical region approximately 2mm in width at the interior border of the 2nd rib

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120
Q

CXR: What should be assessed in stage 5?

A

Check the bony skeleton of the anterior ribs and shoulder girdle

  • Look for changes in density, compare side to side
  • Look for fractures and changes in shape
  • Any erosions
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121
Q

CXR: What should be assessed in stage 6?

A

Neck and soft tissues

  • Start at the neck and note any bony cervical abnormalities
  • Follow line around soft tissue (through axillary region and over the breast)
  • Look for evidence of surgery
  • Look for air in soft tissue
  • Consider skin folds in larger patients
  • Consider posterior and anterior axillary folds
  • Breast tissue
  • Can see the sternocleidomastoid on thinner patients
  • Can sometimes see nipples due to different densities
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122
Q

CXR: What should be assessed in stage 7?

A

Check for wires, catheters and foreign bodies

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123
Q

What should be assessed along these 3 lines?

A
  1. Look for name, date and anatomical markers, consider the apical sections
  2. Check for rotation. See if the lungs are of similar densities. Are they of equal size? Is the trachea central? Is it adequately exposed?
  3. Assess the lung bases. Adequate inspiration (9-10 ribs)
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124
Q

CXR: What are the risky areas that need to be checked twice? Why?

A

Pulmonary apices

Hila

Retrocardiac areas

Costophrenic angles

Lesions hide here!

125
Q

What is a tension pneumothorax and how does it present on a CXR?

A

Opening acts as a one way value

Results in an increase in intrathoracic pressure with each breath

Mediastinal shift away from the affected side

Ipsilateral depression of the hemidiaphragm

Mediastinal compression compromises venous return

Black shadow

126
Q

What is pleural effusion and how does it present on a CXR?

A

Depressed diaphragm

Can contain air or fluid

Massive collection can displace the mediastinum

Look for upward curve against the lateral chest wall

Get a fluid level appearance

127
Q

CXR: What do you need to look for in lung collapse?

A

Movement of the horizontal fissure

Deviation of the trachea

Raised diaphragm (dependent on which lobe)

Variation in radiodensity

Overaeration of affected side to compensate

128
Q

How does consolidation appear on a chest x ray?

A

Appears white

Obliterates mediastinal line

Lung becomes airless

Similar in density to soft tissue

Loss of diaphragm

129
Q

CXR: How would consolidation of the left lower lobe appear?

A

Lose the diaphragmatic border

Keep the left heart border

130
Q

CXR: How would consolidation of the left upper lobe appear?

A

Lost the left heart border

Keep diaphragmatic border

131
Q

What pathology is visible?

A

Teratoma metastases

132
Q

What pathology is visible?

A

Left pneumothorax

133
Q

What pathology is visible?

A

Pleural effusion

134
Q

What pathology is visible?

A

Calcified trachea and bronchi

135
Q

What pathology is visible?

A

Fractured ribs and hydropneumothorax

136
Q

What pathology is visible?

A

Lung abscess

137
Q

What pathology is visible?

A

Acute TB with cavities query

138
Q

What pathology is visible?

A

Sarcoidosis Progressive granulomatous recticulosis of unknown etiology.

Invloves almost any organ. Characterised by non-caseating (caseation – tissue changed into a dry amorphous mass resembling cheese) epitheliod cell tubercules.

139
Q

What pathology is visible?

A

Polycystic lung disease with fluid levels

140
Q

What pathology is visible?

A

Right upper lobe collapse

141
Q

What pathology is visible?

A

Lesion in the right upper lobe

142
Q

What pathology is visible?

A

Consolidation of the right base

Filling of air passages with exudate

143
Q

What pathology is visible?

A

Infection in the right lower lobe

144
Q

What pathology is visible?

A

Pleural effusion in right lung

Fluid level - indicates effusion rather than consolidation

145
Q

What pathology is visible?

A

Pleural effusion right lung

Lateral view

146
Q

What pathology is visible?

A

Left sided mass

147
Q

What pathology is visible?

A

Metastases

148
Q

What pathology is visible?

A

Emphysema with possible effusion

149
Q

What pathology is visible?

A

pneumoconiosis

150
Q

What pathology is visible?

A

Pulmonary calcification

Query old TB

151
Q

What pathology is visible?

A

Cardiomegaly

152
Q

What pathology is visible?

A

Consolidation of lung bases

153
Q

What pathology is visible?

A

Old TB - calcified deposits

154
Q

What pathology is visible?

A

Cardiomegaly

Increase in left ventricle size, possible increase in right atrium size, and left atrium.

Consider mitral disease

155
Q

What pathology is visible?

A

Free air under right diaphragm

156
Q

What pathology is visible?

A

Right pleural effusion

157
Q

What pathology is visible?

A

Opacification of the right lower lobe

158
Q

What pathology is visible?

A

Congestive heart failure

159
Q

What pathology is visible?

A

Diffuse opacities

Fibrosing alveolitis

160
Q

What are the 3 main scan planes used in ultrasound?

A

Longitudinal/saggital

Transverse

Coronal

161
Q

Describe the orientation seen on a longitudinal US scan?

A

Top = skin

Right = Feet

Bottom = Back

Left = Head

162
Q

Describe the orientation seen on a transverse US scan?

A

Top = Skin

Right = Patient’s left

Bottom = Back

Left = Patient’s right

163
Q

How does fluid appear on an US scan?

A

Appears black

Clear fluid should contain no echoes

Some post-cystic enhancement behind the fluid

If it has any internal echoes - suggestive of a thicker fluid

164
Q

How does a solid mass appear on an US scan?

A

Usually well defined

Full of echoes

Mostly echogenic

Can observe posterior shadowing

165
Q

How does air/gas appear on an US scan?

A

Air/gas reflects US

Can obscure the object you are trying to view

Appears very bright

Ususally see linear echoes

166
Q

How do arteries appear in US?

A

Arteries should be pulsatile and have echogenic walls

167
Q

How do veins appear in US?

A

Veins should be non-pulsatile

Thin walls

Should collapse on respiration/val-salva and compression

168
Q

US: What are the components of patient safety to be considered?

A

No harmful effects

Ensure the examinations are appropriate and necessary

Always keep the US power as low as reasonably practicable

Don’t leave the transducer on the patient unless acquiring an image

Keep scanning time to a minimum

169
Q

US: Why is it necessary to use coupling gel?

A

Essential to obtain the image

Eliminates the air interface to allow US transmission into the body

Need to use sufficient for the transducer to glide smoothly

Too much makes it harder to get

170
Q

US: What are the effects of having the gain set too high?

A

Image is too bright

171
Q

US: What are the effects of having the gain set too low?

A

Image is too dark

172
Q

US: What is the procedure for setting the depth of the ROI?

A

Start scanning with the depth set to allow a full view of all major organs

Adjust the depth according to the depth of the ROI

Need to make the ROI as large as possible without losing information off the bottom of the screen

If the depth is not correctly set up, landmarks will be difficult to assess

173
Q

US: How is the focus area indicated and changed?

A

Indicated by a small arrow at the side of the image

Can be moved up or down using the focus control

174
Q

US: What is the effect of increasing the amount of focal zones?

A

Increases resolution

Lowers the frame rate

175
Q

US: When is it better to use only one focal zone?

A

Better for moving objects e.g. aorta

176
Q

US: When is it better to use multiple focal zones?

A

Good for non-mobile superficial objects e.g. testes

177
Q

US: What is the benefit of narrowing sector width?

A

Improves the image

Need to not exclude any of the ROI

Good for looking at the gall bladder and transverse aorta

178
Q

US: What are the 4 movements possible with the probe?

A

Sliding

Rotating

Angling

Dipping/rocking

179
Q

US: Describe the probe movement of rotation

A

Rotation of the probe around a fixed point.

Switching between LS and TS while keeping an organ in view

180
Q

US: Describe the probe movement of angling

A

Alteration of the angle of the probe in relation to the skin

181
Q

US: Describe the probe movement of dipping/rocking

A

Describes gently pusing one end of the probe into the abdoment

182
Q

US: What are the steps for setting up the equipment?

A
  • Power on
  • Enter patient details
  • Annotate the images
  • Select the probe
  • Select the preset
  • Orientate the scan
  • Select transmit frequency
  • Set overall gain
  • Set time gain control
  • Set focus
  • Set depth/magnification/FOV
183
Q

US: How do you decide how to select the transmit frequency?

A

Always use the highest frequency that would provide adequate penetration

This increases spatial resolution

184
Q

US: What is the overall gain?

A

Controls the amount of amplification fiven to all returning echoes regardless of depth

Should be set so soft tissue is mid-grey and fluid is black

185
Q

US: What is time gain control?

A

It corresponds to specific depths within the patient and is used to compensate for increased attenuation with depth.

Need to get similiar structures to appear at the same brightness at all depths

186
Q

US: What is the effect of changing the focus to the depth of the ROI?

A

It increases lateral resolution

187
Q

US: What happens to the frame rate as the field of view is decreased?

A

Increased frame rate

188
Q

What position is this image taken in? Why?

A

The barium is raised at the top of the stomach.

The patient is either lateral or supine.

189
Q

What position is this image taken in? Why?

A

Patient is prone.

The air is at the top of the stomach with the barium collected at the bottom.

190
Q

What position is this patient in?

A

Supine

191
Q

What position is this patient is in?

A

Prone

192
Q

What position is this patient in?

A

Patient is prone

The barium is the transverse colon with air in the ascending and descending colon

193
Q

What position is this patient in?

A

Supine

The air is in the transverse colon.

The barium has collected in the ascending and descending colon

194
Q

US: What is the examination technique for upper abdominal US?

A
  • Need to fast for 6 hours before to assess biliary tree
  • Variable patient positions required
  • Start supine but can do erect, lateral, right and left anterior oblique
  • Minimum of 2 scan planes
  • Curvilinear transabdominal between 3-7MHz
195
Q

US: On a longitudinal scan, what is in each direction?

A

Top: skin

Right: feet

Left: head

Bottom: back

196
Q

US: Describe how veins appear?

A

No bright walls

Walls are indistinct

All collapse on inhalation

197
Q

US: How does the portal system appear?

A

Bright walls

198
Q

US: What is the normal liver appearance?

A

Homogeneous mid grey echo texture

Interrupted by vessels and ligaments

Echogenic thin capsule around the liver

Similar or slightly increased echogenicity when compared to the cortex of the right kidney

Ligaments appear as echogenic linear structures

199
Q

US: What is the portal triad and how does it appear?

A

Portal vein

Hepatic artery

Bile duct

Double barrelled/ parallel doube channel only seen when dilated

200
Q

US: Why does the diaphragm appear bright?

A

It is curved

It focuses the US and therefore it appears bright

201
Q

US: What are the 3 veins visible on a transverse section entering the IVC?

A

Right, left and middle hepatic vein

202
Q

US: What direction should the blood travel in the portan vein and what colour would appear in Doppler?

A

It should travel towards the liver

It should appear red

203
Q

US: What are the consequences of portal hypertension?

A

Increased diameter of vessels

Collaterals develop

Reversed flow in the portal system

Can get splenic varices or collaterals

204
Q

US: In a longitudinal view of the kidney, where is the upper pole?

A

It is located at the bottom

205
Q

US: How do you distinguish between the aorta and IVC?

A

Aorta walls are brighter than the IVC

Normal views of the IVC do not have branches

206
Q

US: What are the liver pathologies that can be seen using US?

A

Haemangioma

Cirrhosis

Hepatocellular carcinoma (HCC)

Metastases

207
Q

US: How does a haemangioma appear?

A

Extremely echogenic

well circumscribed lesions

Appear very bright

208
Q

US: How does cirrhosis appear?

A

May appear normal

Fat and fibrosis is hyperechoic

There are textural changes - coarse and nodular

Has a lobulated outline

Asymmetrical hypertrophy/atrophy

Haemodynamic changes e.g. portal hypertension and splenomegaly

Ascites and HCC

Image gets increasingly brighter over time and will see less of the liver

Caudate lobe often spared so can look larger

209
Q

US: How does a liver metastasis appear and where does it most likely come from?

A

May be solitary or multiple, appearance depends on primary

Likely to be from the bowel or breast

210
Q

US: How does the common bile duct appear?

A

Intrahepatic portion is demonstrated anteriorly and to the right of the portal vein

Extraheptaic is harder to view and is often overshadowed by bowel

Normal calibre = 6mm

More ectactic in elderly = 8-9mm due to degeneration of the elastic fibre wall

211
Q

What colour does the portal vein appear on Doppler?

A

Red

212
Q

US: How would you see a stone in the common bile duct?

A

Often hard to see

Use long oblique view to see the neck of the gall bladder

Can sometimes just see the anterior surface as it is a strong reflector

213
Q

US: What is the normal appearance of the gall bladder?

A

Variable positions, size and shape

Distended

anechoic

pear shaped sac

echogenic thin walls

Can sometimes be absent or previous cholecystectomy

214
Q

US: What are the potential gall bladder pathologies that can be visualised?

A

Choleithiasis (gall stones)

Cholecystitis (inflammation)

Polyps

Adenomyomatosis

Carcinoma

215
Q

US: How do gallstones appear?

A

Calculi appears echogenic with posterior acoustic shadowing

Postcystic enhancement due to decreased attenuation as it passes through fluid

Usually mobile - move patient to clarify

216
Q

US: What is the normal gall bladder wall thickness? How is measured?

A

Less than 3mm when fasting

Measure the anterior wall in the transverse or longitudinal section

Use the anterior wall as it is difficult to delineate the posterior wall from the stomach

217
Q

US: What are the signs of acute cholecystitis?

A

Thickening of the gall bladder wall

Gallbladder tenderness

Gall bladder enlargement

Pericholecystic fluid

Gas in GB

Acalculus in 5-10% of patients

218
Q

US: What are the signs of chronic cholecystitis?

A

Can’t distinguish between acute and chronic with US

Recurrent RUQ pain

Almost always in associations with gallstones

Thickened gall bladder with narrow lumen

219
Q

US: How do gall bladder polyps appear?

A

Small intraluminal echogenic structure

Fixed to the gall bladder wall

does not cast an acoustic shadow

Common

Can be: inflammatory, cholesterol or adenomyomas

Cholesterol most common wth no malignant potential

220
Q

US: How does adenomyomatosis appear?

A

gall bladder mucosa becomes hyperplastic and invaginates forming hypoechoic areaas called Rokitansky-Aschoff sinuses

These sinuses have tiny cholesterol deposits

Causes comet tail artefact

Lumen commonly narrowed from wall thickening

221
Q

US: What are the appearances of gall bladder carcinoma?

A

Variable ultrasound appearances

  • Solid mass occupying lumen
  • Irregular polypoid mass with lumen
  • Irregular thickening gall bladder wall, can be focal or diffuse
222
Q

US: What is the normal pancreas appearance?

A

Homogeneous texture

Echogenicity is age related

Younger = bulky and hypoechoic

Adult = hyperechoic

Older = hyperechoic and tending to atrophy

Margin should be smooth

223
Q

US: What is the scanning technique for visualising the pancreas?

A

Transverse plane in the epigastrium

Different angulations required for different views of the pancreas

Left lobe of the liver can act as an acoustic window

Align the transducer along the long axis of the pancreas to identify the anatomy

A fluid filled stomach can be used to see the tail of the pancreas

Need to see: uncinate process, head, body and tail

224
Q

US: What are the pathologies of the pancreas that can be seen?

A

Pancreatitis +/- pseudocyst

Calculi

Pancreatic carcinoma

225
Q

US: What is the appearance of pancreatitis?

A

Acute with bowel gas

May appear normal at the onset or quickly resolve

Assess for pseudocyst formation

Necrotising pancreatitis may have focal complex lesions

Enlarged oedematous gland +/- focal/lobular lesions

Free fluid in the lesser sac or peritoneal spread of fluid

Reduced echogeniciy

226
Q

US: What is the pancreatic pseduocycst appearance?

A

Echo free mass

New has thin walls, old has thicker walls

Complex internal contents

Irregular borders

May have multiple sites

227
Q

US: What is the normal appearance of the kidneys?

A

Size 10-12cm

Smooth contour with bright line around

Cortex slightly brighter than medually pyramids

Collecting system appears bright and echogenic

Capsule is thin and highly reflective

Relectivity slightly less echogenic than the liver

Pyramids are echo poor areas in the cortex

228
Q

US: What are the renal pathologies that are visible?

A

Renal cysts

Renal calculi

Hydronephrosis

Renal carcinoma

229
Q

US: What are the renal cysts?

A

Echo poor circular area wiht posterior acoustic enhancement

230
Q

US: What is the appearance of renal calculi?

A

Echogenic focus with posterior acoustic shadowing

231
Q

US: What is the appearance of hydronephrosis?

A

Initially appears echogenic then echopoor

232
Q

US: What is the appearance of renal dilation?

A

Echopoor area seen expanding the collecting system

233
Q

US: What is the appearance of renal failure?

A

Maybe normal, increased or decreased in size

Increased echogenicity

234
Q

US: Why are renal stones harder to distinguish?

A

the brightness of the collecting system can make it difficult

235
Q

US: What is the spleen scanning technique?

A

Examined from the left lateral aspect

Coronal and transverse sectons are obtained with the patient supine/ left anterior oblique using an intercostal approach

Gental respiration so as not to obscure the image with lung tissue

236
Q

US: What is the normal spleen appearance?

A

Homogenous echo texture

Smooth and mid-grey in echogenicity

Smooth margins and pointed inferior border

237
Q

US: What are spenunculi and how do they appear?

A

Accessory spleen

Normal variant

Near splenic hilum

Usually 1-1.5cm in diameter

Can enlarge and function as a normal spleen

238
Q

US: What are the splenic pathologies that can be seen?

A

Splenomegaly >13cm

Cysts - echopoor with PCE

Haemangiomas - well defined and echogenic

Calcifications

Abscesses

Trauma

Malignancy

239
Q

What may be the cause of splenomegaly?

A

Non-specific sign

May be due to:

Trauma

Portal venous congestion

Systemic infection

Neoplastic conditions

Haematological disorders

240
Q

US: What is the appearance of a spleen abscess?

A

Varies

From echo free to mixed with solid and cystic components

May contain septae and / or debris

241
Q

What are the consequences of splenic trauma and what are their appearances?

A

Subcapsular haematoma

Extra-capsular haematoma

Splenic rupture - irregular area of reduced reflectivity

Acute haematomas - well or poorly defined cresent shaped areas of increased reflectivity

242
Q

US: What are the appearances of the spleen in leukaemia?

A

Acute - may be slightly enlarged with reduced echogenicity

Chronic - grossly enlarged with reduced reflectivity

243
Q

US: What is the appearance of lymphoma in the spleen?

A

Usually diffuse

Enlarged

Homogenous with decreased reflectivity

Appearances vary

244
Q

US: How is a patient prepared for a gynae exam?

A

Full bladder

1-1.5 pints of water 1-1.5 hours before the exam

This moves bowel gas to enable the ovaries to be seen (uses the bladder as a window_

245
Q

US: What transducer is used in a gynae US?

A

Curvilinear transabdominal 3-7MHz

OR

Curvilinear transvaginal 5-8MHz

246
Q

US: What is the normal vagina appearance?

A

Thin walled muscular H structure

Can be used as a landmark during scanning

3 thin reflective echoes inferior to the urinary bladder

247
Q

US: What are the 3 layers of the uterus and how do they appear on US?

A

Parametrium = outer serous layer. Highly reflective linear echo

Myometrium - low level homogenous echoes of muscular tissue

Endometrium = innter layer. Cavity lining. Changes throughout the menstrual cycle and in pregnancy

248
Q

What are the 3 uterus positions?

A

Anteverted - most common. Cervix and vagina form a 90 degree angle

Anteflexed = the angle between cervix and vagina is less than 90 degrees. Visualisation is increased with bladder filling

Retroverted/retroflexed - uterine fundus is placed caudally and is a normal variant. Can result poor visualisation of endometrium TA (use TV)

249
Q

What are the difference uterine variants?

A

Uterus develops from the fusion of the inferior aspec of the 2 Mullerian ducts at 4 weeks. Variants occur if this is disrupted

Didelphic - complete failure of fusion. 2 uteri each with separate cervical opening +/- double vagina

Bicornuate - partial fusion, double uterine cavities separated by a septum

Unicornuate - only one duct due to the abscence of paramesonephric duct

250
Q

US: What is the normal appearance of the ovaries?

A

Low reflectivity of outline

Thin fibrous layer of tunica albuginea

Cortex contains follicles

Inner layer: medulla of connective tissue, contains vessels, strong reflectivity

Must label R and L

Often they are on different planes so can’t be seen together

251
Q

US: Why use a TV probe?

A

Allows further evaluation of uterus and ovaries

Higher frequency transducer which increases resolution

Decreases the distance to the area of interest means reduction in penetration is not a problem

More detail

252
Q

US: What are the uterus pathologies that are visible?

A

Myometrium - fibroids

Endometrium = endometrial carcinoma and polyps

253
Q

US: What is the appearance of fibroids?

A

Well defined mass of altered echogenicity

May contain calcification

Necrosis would causes a decrease in echogenicity

254
Q

US: What is the appearance of endometrial carcinoma?

A

TV scan

Increasingly common in postmenopausal women

Thickened or irregular endometrium

Loss of myo/endometrium differentiation

255
Q

US: What is the normal thickness of the endometrium?

A

Less than 4mm

256
Q

US: What is the appearance of polyps?

A

Echogenic area seen within the endometrial cavity

May be surrounded by fluid (makes it easier to see)

May see a feeder vessel with colour doppler

257
Q

US: What are the ovarian pathologies?

A

Masses e.g. carcinoma

Cyst e.g. simple/haemorrhagic/dermoid

Functional - polycystic ovarian syndrome

258
Q

US: How does a simple ovarian cyst appear?

A

Well defined

Echo free

Unilocular

Thin smooth walls

259
Q

US: What components of a cyst need to be considered?

A

Uni/multi-locular?

Solid?

Cystic?

Papillary proliferations?

Septae?

260
Q

US: How does a haemorrhagic ovarian cyst appear?

A

Appearance varies with time

Diffuse homogenous low level echoes, septated, clot retraction

261
Q

US: What are the features of a benign mass?

A

Unilocular cyst

Presence of a solid component less than 7mm

Presence of acoustic shadowing

Smooth multilocular tumour <100mm

No blood flow

262
Q

US: what are the features of a malignant ovarian tumour?

A

Irregular

Solid

Ascites

At least 4 papillary structures

Irregular multilocular solid tumour>100mm

very strong blood flow

263
Q

US: What is the appearance of endometriotic cyst?

A

Filled with homogenous low level echoes

No loculations or solid elements

Same internal echogenicity throughout

Maybe depositsof endometrium in the pelvis

264
Q

US: What are the features of polycystic ovaries?

A

Increased ovarian volume > 10ml

Follicle number >12

Follicle diamete 2-9mm

265
Q

What are the features of a dermoid ovarian cyst?

A

Cystic teratoma

Tumour composed of a number of tissue e.g. skin, hair follicles and sweat glands

Complex mass of different echogenicity and appearance

266
Q

US: What are the reasons for thyroid ultrasound referral?

A

Palpable mass

abnormal thyroid function test

Biopsy of fine needle aspiration

267
Q

US: What is the technique for imaging the thyroid?

A

Patient supine with neck extended

TS and LS of entire gland from carotid to trachea

If it extends retrosternally, scan during swallowing to lift above the thoracic inlet

Should include vessels and nodes in the neck

268
Q

US: What probe should you use to image the thyroid?

A

Linear probe 7-17MHz

If patient is large use a lower frequency curvilinear

269
Q

US: What is the normal appearance of the thyroid?

A

Homogeneous echotexture

Greater reflectivity than adjoining musculature

Thin reflective capsule

Vascular structures may be visible

In LS - lobes appear oval with a slender elongated upper pole and rounded inferior pole

Can have normal colloid cysts

270
Q

What is the role of US in the thyroid?

A

Identify signs associated with malignancy

Visualisation of infiltration/spread to lympth nodes

Small lesion detection

Locating nodules for FNA and biopsy

Enables histological evaluation

271
Q

US: What are the thyroid pathologies that are visible?

A

Masses - cyst/carcinoma

Thyroiditis

Multi-nodular goitre

272
Q

US: What are the appearances of a benign nodule of the thyroid?

A

Isoechoic or hypoechoic

Well defined borders

Echo poor halo

May have cystic components - can be colloid or haemorrhage

May be heterogeneous

Comet tail artefact may be present

Perinodular blood flow pattern

Smooth walls, well defined

273
Q

US: What is the appearance of thyroiditis?

A

Enlarged gland

Heterogeneous

Mixed echogenicity

Increased blood flow

274
Q

US: What is the appearance of thyroid malignancy?

A

Predominantly hypoechoic

70% solid 30% cystic component

Microcalcifications

Intranodular blood flow pattern

275
Q

US: What are the indications for referral for aorta US?

A

pulsatile mass

acute abdomen +/- back pain, collapse or trauma

Screening

Monitoring of AAA

Post-op complications

276
Q

US: What is the scanning technique for the aorta?

A

Easiest to find in TS 30-40mm above the umbilicus

Assess whole length from diaphragm to bifurcation

Look for origin or renal arteries

Ensure TS image is as round as possible

277
Q

US: How do you locate the renal arteries?

A

SMA may be used as a landmark

Adapt technique to improve visualisation

Use the right lobe of the liver or the right kidney as an acoustic window

Right anterior oblique view

Sometimes called a rose-thorn view

278
Q

US: What is the scanning technique for a LS of aorta?

A

Turn transducer 90 degrees

Assess from diaphragm to bifurcation

Identify SMA and coeliac axis

279
Q

US: What is the normal appearance of the aorta?

A

In TS - posterior to IVC, superior to renal arterie.

Circular in shape

Coeliac axis and branches appear like gull’s wings

Anechoic vessel with highly reflective border

Follows the spine and tapers inferiorly

On LS coeliac axis arises from aterio-superior aspect with SMA seen below that following the course of the aorta

280
Q

US: What measurements of the aorta should be taken?

A

Measure just inferior to the renal arteries unless worried about AAA then measure at widest point

TS - must be a 90 degrees (no salami slice)

Measure antero-posteior inner edge to the inner edge in LS and TS

Normal <3cm in diameter

281
Q

US: What is the appearance of AAA?

A

In LS aorta > 3cm

Loss of smooth tapering shape

Usually seen central, anehoic true lumen surrounded by more echogenic thrombus

Thrombus may calcify

In TS large, roundish mass with anechoic true lumen

Thrombus may be irregular / thickened

If >5.5cm consider for surgery

282
Q

How do the different tissues appear on abdominal x ray?

A 
Gas = black
Fat = dark grey

Soft tissue = light grey

Bone = white

Metal artefacts = white

283
Q

AXR: What can the location of organs depend on?

A

Anatomical location

Affect on anatomical postion of body habitus

Affect on anatomical position due to patient position and motility of organs

284
Q

AXR: What fat stripes are visible?

A

Properitoneal fat stripe - outlines ascending and descending colon

Can also see the fat stripes of abdominal wall separating muscles

285
Q

What are the 9 areas of the abdomen?

A

R and L hypochondriac

Epigastric

R and L lumbar

Umbilical

R and L iliac

Hypogastric

286
Q

AXR: What are the 4 different types of body habitus? How common are they?

A

Hypersthenic 5%

Sthenic 50%

Hyposthenic 35%

Asthenic 10%

287
Q

Describe the hypersthenic body habitus?

A

Heart is nearly transverse

Lungs are short

Apices at or near the clavicles

Diaphragm is high

Stomach is high, transverse and central

Colon is high around the periphery

288
Q

Describe the sthenic body habitus

A

Heart moderately transverse

lungs are moderate length

diaphragm is moderately high

stomach is high upper left

colon spread evenly

289
Q

Describe the asthenic body habitus

A

heart nearly vertical at the midline

lungs are long

apices are above the clavicles

diaphragm is low

stomach is low and medially (in pelvis on standing)

colon is low and folds on itself

290
Q

What are the differences between supine and erect abdominal radiographs?

A

Supine are easier to review, abdo contents more evenly spread and is of more uniform thickness

Erect - abdo wall sags and is no longer of uniform thickness

291
Q

AXR: Describe the appearance of barium and air in the stomach in erect, prone, supine and lateral images

A

Erect and prone - air rises to the top, barium sinks to the bottom

In supine, the air is squashed down at the bottom

In lateral the air is concentrated to the centre of the stomach with barium at the top and bottom

292
Q

AXR: What is the distribution of air and barium in the large intestine when supine and prone

A

SUPINE - air in the transverse colon and sigmoid as well as base of stomach

PRONE - air in the ascending and descending colon

293
Q

AXR: WHat should be considered to determine the patient position and direction of x-ray beam?

A

Position of contrast agent

Bony appearances

Action of gravity

Anatomical differences between right and left

294
Q

AXR: What additional factors determine position of abdominal contents?

A

Phase of respiration

Loss of muscle tone

presence of pathology

Age

Quantity of contents in hollow viscera

295
Q

AXR: What should an initial inspection check?

A

Correct patient and date of examination

Correct markers

Correct area

Optimum contrast

Optimum density

Resolution

Artefacts

Collimation

Are repeats required?

Pathology

296
Q

AXR: What are the 5 areas of interest to check?

A

Abdominal gas pattern

Biliary tree and right urinary tract

Left urinary tract and bladder

Bones

Soft tissues

297
Q

AXR: What are the 3 types of abnormality?

A

Opacity - area of decreased image density

Radiolucency - area of increased image density

Distortion and displacement

298
Q

AXR: What is the standard projection for GI X-ray?

A

AP with patient supine

299
Q

AXR: What are the upper limits of the normal diameter of:

Small bowel

Colon

Caecum

A

Small bowel = 3cm

Colon = 6cm

Caecum = 9cm

300
Q

AXR: What are the defining features of the small bowel?

A

NO haustra

Valvulae conniventes

Many loops

Small radius of curvature

Loops are CENTRAL

3-5cm dimeter

No solid faeces

301
Q

AXR: What are valvulae conniventes?

A

Mucosal folds that cross the full width of the bowel

Only found in the small intestine

302
Q

AXR: What are the defining features of the large bowel?

A

Haustra (but not in sigmoid)

NO valvulae conniventes

Few loops

Large radius of curvature

Loops are peripheral

5cm diameter loops

Solid faeces

Have Taenia coli

303
Q

AXR: What are the pathologies that can be found in the biliary tree and urinary tracts?

A

Increased opacity in = gall stones, renal calculi and ureteric calculus

Increased radiolucency = gas in the biliary tree

Distortion = size and the shape of the kidney

304
Q

AXR: Where are the possible areas that calcification can occur?

A

Adrenal

Renal

Gall bladder

Pancreas

Aortic aneurysm

Fibroid

Bladder

Prostatic

305
Q

US: What are the relations of the ovary that can be seen?

A

Ovary, dominant follicle, follicles, bladder.

anteriorly: broad ligament, mesovarium, ovarian vessels, obliterated umbilical vein
posteriorly: ureter, internal iliac vessels, pelvic wall
superiorly: external iliac vessels
inferiorly: levator ani
medially: ovarian ligament
laterally: obturator vessels and nerves

306
Q

US: What is the appearance of the ovaries?

A

homogenous echotexture with a central echogenic medulla
volume on ultrasound can be calculated with following formula 5:

0.523 x length (cm) x width (cm) x depth (cm)

307
Q

What are the relations of the vagina that can be seen?

A

anteriorly - cervix, bladder, urethra
posteriorly - pouch of Douglas, Denonvillier’s fascia, perineal body
laterally - levator ani, pelvic fascia, ureters

308
Q

What are the relations of the uterus?

A

anteriorly - bladder; uterovesical pouch
posteriorly - rectum; pouch of Douglas
laterally - broad ligament; uterine vessels

uterine tubes open into its upper part

inferiorly - uterine cavity communicates with that of the vagina

309
Q
A

Intercalation (4 decks)

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