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Rad TG Flashcards

1
Q

What are the five types of different imaging modalities?

A
  1. X-Ray
  2. Computed Tomography
  3. Magnetic Resonance
  4. Ultrasound
  5. Nuclear Medicine
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2
Q

What Imaging uses a single pulse of ionizing radiation, is good for bones and airspaces, bad for soft tissue and overlapping structures, and is white to start with?

A

X-Ray

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3
Q

How does brightness correlate in the X-Ray?

A

Dense material blocks the radiation and the film brightens. Less dense material blocks fewer rays and the film darkens.

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4
Q

What are the five different radiographic densities?

A 
Air (darkest)
Fat (Less dark)
Fluid/Blood/Soft Tissue (gray)
Bone (White)
Metal/Contrast (Most White)
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5
Q

X-Rays are a two dimensional representation of a three-dimensional object meaning that they can ________?

A

Hide underlying structures depending on the viewpoint making it important to obtain more than one view.

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6
Q

What is the Anteroposterior (front to back) view used for?

A

If patient is unable to stand or sit for a PA view, lower quality than a PA view, back is placed next to film, heart is magnified and borders are fuzzier.

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7
Q

What is the lateral (side view) used for?

A

Usually taken in conjunction with a PA view, allows viewing of structures behind the heart (mediastinum) and provides three dimensional image.

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8
Q

What is the Oblique view used for?

A

Mostly on limbs.

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9
Q

What is the posteroanterior (back to front) used for?

A

Object that is closer to the film has sharper borders, chest is placed closer so most important structures are closer to film, and heart size is minimally magnified and the borders are sharp.

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10
Q

What method of imaging is similar to X-ray, emits radiation, and shows color in black, white, and gray depending on density?

A

Computed Tomography

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11
Q

What is Computed Tomography good for?

A

Bone, airspaces, some soft tissue and overlapping structures.

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12
Q

What is CT bad for?

A

Some soft tissues (nerves, muscles, connective tissue), patients with retained metallic objects (causes artifacts).

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13
Q

What produces the “slice” of a patient?

A

X-ray tube of the CT spinning rapidly around the patient.

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14
Q

What views are used in CT Scans?

A

Sagittal or Median
Coronal
Axial or Transverse or Cross-Sectional

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15
Q

Which imaging type uses electromagnetism and radio frequency properties?

A

Magnetic Resonance Overview.

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16
Q

What is MRI good for?

A

Soft tissue (nerves, muscles, connective tissue, brain, joints). In addition, there is no exposure to ionizing radiation.

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17
Q

What is MRI bad for?

A

People who cannot hold still or have ferrous metal in the body. MR views are identical to CT. It is time consuming.

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18
Q

How does ultrasound work?

A

Uses sound waves similar to SONAR.

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19
Q

What is Ultrasound good for?

A

Determining fluid vs solids, abdominopelvic imaging, and assessing blood flow. In addition, it is rapid and portable and doesn’t produce radiation.

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20
Q

What is ultrasound bad for?

A

Things under bones and air filled chambers, deep things.

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21
Q

What are the Ultrasound views?

A

Longitudinal (sagittal)

Transverse (axial)

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22
Q

What type of imaging requires a radioactive agent to be given intravenously?

A

Nuclear Medicine

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23
Q

How does Nuclear Medicine work?

A

The intravenous agent participates in physiologic processes while emitting radiation, the radiation is detected and is used to create an image showing the distribution of the agent with in the body.

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24
Q

What is a typical use of Nuclear Medicine?

A

Detecting stress fractures before being visible on x-ray.

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25
What is nuclear medicine good for?
Detecting normal or abnormal physiologic processes.
26
What is nuclear medicine bad for?
Showing less anatomic detail.
27
Upon pre-read what must you do before anything else?
Confirm patient, date, body part, type, number of views, and check to see if any comparison films exist.
28
How do you assess technical adequacy?
Utilizing the RIP technique. Rotation, inspiration, and penetration.
29
What should you be looking for during the rotation portion?
Clavicles relative to the vertebral column and equally spaced. If not properly aligned, it may mean abnormal.
30
What should you be looking for during inspiration?
Look at the ribs. Should be able to count 9-10 ribs with the posterior ribs being easier to see.
31
What are you doing during the penetration phase?
Should be able to see the ribs through the heart, should barely see the spine through the heart, should see pulmonary vessel near the edges of the lungs.
32
What might you see on over-penetrated film?
Lung fields almost completely black and may suggest pneumothorax.
33
What might an under-penetrated film suggest?
Soft tissue structures are obstructed with images appearing bright suggesting consolidation like pneumonia.
34
What are the steps when reading a chest x-ray?
Do the pre read, Assess technical adequacy using RIP, and conduct a systematic method (ABCDE).
35
What does ABCDE stand for?
``` A-Airways B-Bones C-Cardiac Shadow D-Diaphragm E-Everything else ```
36
When do you order imaging for common primary care complaints?
To confirm a suspicion, to impact your treatment, and should include a relevant and brief patient history with the purpose of the evaluation.
37
When is an ankle series indicated?
Pain in the malleolar zone, bone tenderness at the posterior edge of lateral or medial malleolus, or inability to bear weight both immediately after the injury and for four steps in the evaluation room.
38
When is a foot series indicated?
Has pain in the midfoot region, has bone tenderness at the base of the 5th metatarsal, or inability to bear weight both immediately after the injury and for four steps in the evaluation room.
39
For suspicion of stress fractures what might be seen?
An initially normal x-ray, bone scan may show abnormalities before x ray findings. Consider a CT or MRI.
40
When is a knee series indicated?
When age is greater than 55, isolated tenderness of the patella, tenderness at the head of the fibula, inability to flex the knee to 90 degrees, inability to bear weight, ottawa knee rules, suspected ligamentous injury, if plain radiographs are negative but you suspect fracture. Use CT for bone, MRI for ligament.
41
When is a shoulder indicated?
Traumatic cause, presence of pain, loss of range of motion.
42
Plain films will be able to identify?
Fractures, dislocations, arthritis, AC joint or Sternoclavicular joint injuries.
43
What should MRI be used for?
Preferred for labral, ligamentous or rotator cuff injuries.
44
How should a radiograph of the hand be determined.
Based upon clinical assessment, suspected injuries, and physical examination.
45
If a fracture of the phalanx is suspected what view should be used?
Anterioposterior and true lateral of an individual digit.
46
If a fracture is close to the joint what view is useful?
Oblique view.
47
What radiograph type should be used when a fracture that cannot be delineated because of superimposed digits, such as the base of the proximal phalanx.
Entire hand.
48
What do metacarpal fractures require?
AP, lateral, and oblique views.
49
Scaphoid fractures should get a ______?
Scaphoid series.
50
How are hand fractures described?
Radiologically described primarily by their location, geometry, and whether comminution is present.
51
What is the most precise method of describing a hand fracture?
To name the broken bone and finger involved and then further anatomic details of the exact location of the fracture.
52
What are the anatomical sights for phalanges and metacarpals?
Head, neck, shaft, and base.
53
What do tuft fractures refer to?
Fractures involving the head of the distal phalanx.
54
What are the anatomical sites of scaphoid fracture?
Tubercle, waist, proximal pole, and distal pole.
55
What do intra-articular fractures refer to?
Fractures involving the joint.
56
What views are usually obtained for a patient with chronic wrist pain?
Posteroanterior, lateral, and oblique views of the wrist are usually obtained.
57
How many degrees of rotation when evaluating relative lengths of the radius and ulna.
0 degrees with a PA view and the wrist held in neutral.
58
The lateral radiograph is important for assessing carpal alignment with special attention to what?
Lateral view must be obtained with the wrist in 0 degrees of rotation and the radial shaft and third metacarpal long axis collinear.
59
A scaphulonate angle greater than what suggest possible scapholunate instability?
60 degrees.
60
An angle of less than _____ degrees suggest ulnar-sided wrist instability.
30 degrees.
61
What are some additional views to look for specific abnormalities?
Scaphoid view with wrist in ulnar deviation, clenched fist view to check for scapholunate joint space widening, carpal tunnel view, hook view to check for hamate fractures.
62
Osteoarthritis of the radiocarpal joint is characterized by what?
Narrowing of the joint space and sclerosis of the articular surfaces.
63
What is the elbow?
A complex synovial joint formed by the articulations of the humerus, the radius, and the ulna.
64
What are the three articulations of the elbow?
Radiohumeral, ulnohumeral, radioulnar.
65
What is radiohumeral?
Capitellum of the humeus with the radial head.
66
What is ulnohumeral?
Trochlea of the humerus with the trochlear notch of the ulna.
67
What is radioulnar?
Radial head with the radial notch of the ulna.
68
What are the typical radiographs for the elbow?
Ap and lateral projections as well as an oblique view to better visualize the radial head.
69
When a fracture is not seen but there is clinical suspicion what view is indicated?
Coyle's view.
70
What should the presence of joint effusion without fracture identification be treated as?
A non-displaced radial head fracture.
71
How are elbow effusions best seen?
Lateral projection where fluid in the joint capsule elevates the pericapsular fat.
72
What does an elevated anterior fat pad indicate?
Sail sign, implication of effusion.
73
How are dislocations of the elbow named?
For the direction the radia and ulna dislocate relative to the humerus.
74
What is one of the most obvious injuries characterized by bulging and retracted muscle?
Biceps tear. Soft tissue injuries are more difficult to assess using radiographs.
75
When is imaging indicated for back injuries?
After the first 4-6 weeks unless back pain is present with progressive neuro findings or cauda equina symptoms, constitutional findings, traumatic case, curresnt or history of malignancy, the elderly, infectious risk, chronic steroid use, failed conservative management, or at risk for osteoporosis.
76
When is MRI the imaging of choice for back pain?
With prior surgery, suspected infection, spinal cord injury, tumor, or cord compression.
77
When should you consider imaging for a headache?
Associated with head/neck trauma, with new, worse or new features, or abrupt onset headache, focal neurologic signs or symptoms, thunderclap headache, headache radiating to the neck, persistent positional headache, temporal headache in older than 55 years of age, or a suspected infection.
78
What are the common fractures observed radiographs?
``` Oblique Transverse Spiral Overriding Distraction Torus Greenstick Comminuted ```
79
Oblique
Has angulated fracture line.
80
Transverse
Runs perpendicular to the shaft of the bone.
81
Spiral
Has a multiplanar and complex fracture line.
82
Overriding
One bone is displaced over the other.
83
Distraction
Fragments are separated by a gap.
84
Torus
Looks like a bump classified as incomplete fracture seen in children.
85
Greenstick
Fractures by bending like a green twig classified as incomplete fracture seen in children.
86
Comminuted
Have more than two fracture fragments.

Rad and Lab (6 decks)

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