Radiology

Question 1

Which organs are most radiosensitive?

Answer 1

Abdominal organs, pelvic organs and breasts are very/most radiosensitive therefore must carefully consider scans involving ionising radiation involving these areas.

E.g. CT abdo pelvis has higher risk, X-ray lumbar spine also has increased risk due to abdominal organs being in view

*X-ray risk.com is a good website to calculate risk of scan and may be useful if patient asks

Question 2

When requesting a scan, what information must be included so that the radiologist can decide whether scan is appropriate?

Answer 2

Got to provide enough information for radiologist to decide if investigation is appropriate and also provide information to help them interpret findings:

• Full name, DOB, address, NHS number or hospital number
• Patient demographics (e.g. age, sex)
• Clinical details:
  
  • Presenting complaint/reason for admission (summary)
  • Clinical findings on examination
  • Suspected clinical diagnosis (i.e. why are you requesting the scan)
• Relevant investigation results (including any available histology or previous relevant imaging)
• PMH (including conditions, allergies, if on metformin, potential contraindications e.g. metal or pregnancy)
• Investigation modality you are requesting
• Mobility/mode of transport
• Your details (Name, grade, bleep/contact, GMC number)

*Must state if on metformin as if you need scan with contrast medium may need to stop taking before scan and not take for 2/7 after as contrast can decrease renal function which could then increase risk of lactic acidosis due to metformin

Question 3

State some contraindications for MRI

Answer 3

• Any metal in body (e.g. pacemaker, metallic valves, metal foreign body in eye , cochlear implants, brain aneurysm clips etc…) “Do you have any metal in your body? Any devices?”
• Claustrophobia
• Inability to lie still

Question 4

State some risk associated with contrast used in radiological scans

Answer 4

• Allergy (including anaphylaxis)
• Contrast induced nephropathy
• Contrast soft tissue induced extravasation (this can theoretically induce compartment syndrome presenting with usual compartment syndrome symptoms. Extravasation is common but compartment syndrome because of it is not)

*NOTE: if someone’s eGFR is low but need scan, will be asked to hydrate patient prior to scan and monitor eGFR

Question 5

If you want to image bowel, you may do CT colonogram (this involves relaxing bowel using buscopan before insufflating bowel with CO2 via catheter through back passage). Be aware there are some risk associated with buscopan so ensure you check (see below)

Answer 5

• Unstable cardiac disease
• Acute angle glaucoma
• Myasthenia gravis
• Prostate disease
• Paralytic ileus

Question 6

If a patient is going for interventional radiology, you should prep them as if they were going to theatre; true or false?

Answer 6

True; should have same considerations e.g.:

• Investigations:
  
  • Coagulation screen (INR)
  • FBC (Hb, platelets >50)
  • ?G&S (depending on complexity of procedure)
• Stopping anticoagulation (see guidelines as procedure dependent)
• NBM
  
  • Stop diabetic drugs/stop insulin/consider sliding scale etc…
• Cannula in situ