Radiology 🩻 Flashcards
1
Q
Definition of interventional radiology
A
- A subspeciality which provides minimally invasive techniques with the help of imaging modalities to diagnose or treat condition
2
Q
Advantages of interventional radiology
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3
Q
Indications of interventional radiology
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4
Q
Definition of Angiography
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- The Radiological examination of Vessels after introduction of a contrast medium
5
Q
History of Angiography
A
6
Q
What is the basic principle of Angiography?
A
Seldinger Technique
7
Q
Definition of Seldinger Technique
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A percutaneous technique for arterial and Venous access
8
Q
History of Seldinger Technique
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In 1953, Seldinger described a method for catheterization of vessels
9
Q
What is the most commonly used in Seldinger Technique?
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Femoral artery
10
Q
Equipment for Seldinger Technique
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- Seldinger needle
- Guidewires
- Catheters
- Contrast media
11
Q
Size of Seldinger Needle
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18-Gauge
12
Q
Usage of Seldinger Needle
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Single use Sterile needle (disposable)
13
Q
Parts of Seldinger Needle
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2 parts
- A solid inner needle
- A thin Outer wall needle for smooth passage
14
Q
Use of guidewires
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- Guide the catheter
- allow safe introduction of catheter into the vessel
15
Q
Characters of guidewires
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- made of stainless steel
- Usually about 145 cm long
16
Q
Parts of guidewires
A
17
Q
Characters of catheters in Sildenger technique
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- Many shapes and sizes
- Diameter is given in French (3Fr=1mm)
18
Q
Tips at the end of guidewires
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19
Q
Examples of catheres and their discription, indications used for Sildenger Technique
A
20
Q
Contrast media used in Sildenger Technique
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Initially: Ionic iodine compounds were used
Now: None ionic contrast media are used as they have low adverse reactions and low physiological problems
21
Q
Before the procedure Sildenger Technique
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22
Q
Steps of Sildenger Technique
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- Before the procedure
- The procedure
- After the procedure
23
Q
The Procedure Sildenger Technique
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24
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After the procedure Sildenger Technique
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25
What does interventional radiology suite consist of?
- Two rooms
- Equipment
26
Risks & Possible complications of **Sildenger Technique**
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Rooms in interventional radiology suite
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Advantages of X-ray apparatus for interventional radiology
- More massive, Flexible, Expensive & Advanced
- More heat load
- Gives more serial images
29
Shape of X-ray apparatus for interventional radiology
30
Importance of Generators in X-ray
Generation of x-ray
31
Characters of Generators in X-ray
High frequency and high-voltage
32
Components of **Generators in X-ray**
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Cathode in X-Ray
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Anode in X-Ray
35
Definition of **focal spot**
- The area of the anode surface which receives the beam of electrons from the cathode
36
Type of x-ray tube in X-ray apparatus for interventional radiology
Ceiling track-mounted X-ray tubes
37
Types of focal spot
38
What does the size of focal spot depend on?
Depends on the size of the electron beam
39
Number of X-ray tubes for interventional radiology
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Types of image receptor in X-ray apparatus for interventional radiology
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Movement of patient couch in X-ray apparatus for interventional radiology
42
Definition of **Nuclear medicine**
- Branch of medicine that uses radioactive substances in the diagnosis and therapy
**The radioactive substance is called radio tracer, or radio pharmacuetical**
43
Steps of imaging in **Nuclear medicine**
- Selection of isotope
- Administration of the radioactive substances
- Record of gamma rays
44
Definition of **Radioisotopes of an element**
45
Properties of **Ideal radioactive isotope**
46
How to make sure that the isotope reaches the organ of interest?
47
What is the most common (Isotope) used?
Technetium
48
Roots of administration of radioactive substance
- IV
- subcutaneous injection
- Inhalation
- Ingestion
49
How our Gama rays emitted from radioactive substances recorded?
- Gamma rays are collected from outside the body by special instrument called Gamma camera
- They may be detected in a sample of body fluid, like plasma or urine
50
What are different types of radionuclide imaging procedure?
51
Definition of **Planar Scintigraphy**
- Planar Imaging produces a 2D Image with no depth, information and structures at different depth are supeimposed
52
Compare between PET & SPECT
53
What are hybrid scanning techniques?
- A combination of two techniques
54
Examples of hybrid scanning techniques
- PET + CT
- PET + MRI
- SPECT + CT
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Advantages of hybrid scanning techniques
56
Applications of radioactive isotopes in diagnosis
57
Applications of radioactive isotopes in therapy
- Radioisotopes are administrated to treat disease
- Example: Management of malignancies (tumor tissue are attacked by of radiation)
58
What properties do **technetium** have?
59
Other radioactive substances and their use
60
Radioactive iodine
- used in thyroid scan
61
99mTc pertechnetate
- Used in thyroid image
62
99mTc-MIBI
Used in pre-operative localization of parathyroid gland
63
Iodo cholesterol 131 labeled 6 iodo methyl-19 norcholesterol
Used in:
- Cushing disease
- Cortisol producing adenoma
- Primary aldosteronism
(adrenocortical imaging)
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(133 I) iodohippuric acid
Used in diagnosis of:
- Kidney infections and obstruction
- Diagnosis of imbalance of function between two kidneys
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99m Tc-DTPA
- Measurement of GFR
66
Xenon 133
Used in lung function evaluation
67
Applications of nuclear imaging in general
68
What is the aim of bone scan?
- evaluate the distribution of active bone formation
69
Indications of bone scan
70
What is the radiopharmaceutical used in bone scan?
- Phosphate analogues labeled with 99m TC
71
Indications of thyroid scan
72
What is the radio pharmaceutical used in thyroid scan?
73
Definition of **V/Q lung scan**
- A scintgraphic examination of the lung that evaluates pulmonary vascular perfusion and segmental bronchioalveolar tree ventilation
74
Indications of **V/Q lung scan**
- Suspected Pulmonary Embolism
- Monitor lung fuction adter lung transplant
- Preoperative estimates of lung function in lung cancer patients before pneumonectomy
75
What is the radio pharmaceutical used in **V/Q lung scan**?
76
Indications of renal scan
77
What is the pharmaceutical used in renal scan?
78
What is the gamma camera used in myocardial perfusion scintgraphy?
- SPECT is the standard method for myocardial perfusion scintgraphy
- It gives cross-sectional three-dimension along the short and long axis of the heart
79
What is the radio pharmaceutical used in myocardial perfusion scintgraphy?
80
When are these radio pharmaceuticals administrated?
- They can be administrated under stress as well as resting conditions
- Stress conditions may be caused by treadmill or specific drugs
81
Imaging (myocardial perfusion scintgraphy)
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History of x-ray
83
What kind of radiation are x-rays?
- x-rays are electromagnetic radiation
84
How does X-ray work?
- X-ray machine sends individual x-ray particles through the body
- The images are recorded on a computer or film
85
# cz
Production of radiograph
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Principle of x-ray production
- X-Rays are generated when electrons that have been accelerated to great velocity hit a metallic anode
87
Steps of x-ray production
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X-ray interaction with a patient
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How much energy does X-ray require?
90
What are clinical applications of x-ray with contrast?
91
What are clinical applications of plain x-ray?
92
What are hazards of x-ray?
- Ionizing radiation does have some risks to consider
- But it is also important to remember that x-rays can help detect diseases or injury at early stages, and consequently be treated appropriately (it's life-saving)
93
Risks of X-Ray
94
What are factors that cause higher risk of x-ray?
factors which cause higher risk:
- A higher number of x-ray exams
- Receiving x-rays at a younger age
95
How to minimize risk of x-ray?
96
X-ray during pregnancy
97
What are factors that increase risk of X-Ray?
98
Risk of x-ray during lactation
- Safe
99
Definition and principle of **Ultrasound**
100
Frequency of sound in **Ultrasound**
- The audible sound for human ear: Ranges from 20 - 20,000 HZ (hertz).
- Sound waves used in ultrasound machine: Ranges from 2 - 20 MHZ (megahertz).
101
difference in sound transmission in different tissues
**Ultrasound**
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Types of transducers
103
How does the transducer of **Ultrasound** work?
104
Types of **Ultrasound** Images
105
Applications of **Ultrasonography**
106
What types of energy does a transducer convert?
The transducer converts one type of energy into another:
- Electrical and Mechanical (sound).
107
Definition of **Obestetric Ultrasound**
- It is the use of ultrasound in pregnancy, to create real-time visual images of the developing embryo in the uterus.
108
Imaging in **Obestetric Ultrasound**
109
what is the most common use of **Ultrasound**?
Abdominal & pelvic ultrasound
110
Diagnostic use of **Abdominal & pelvic ultrasound**
Examination of abdominal & pelvic organs as regard:
* Size - Echogenicity - Masses.
Help diagnose the causes of acute abdomen pain such as:
* GB stones.
* Ovarian torsion.
* Renal stones.
* Appendicitis.
**Fast US**
- Used in emergency Searching for internal hemorrhage & Parenchymatous injury in pelvi-abdominal trauma.
111
Interventional use of **Abdominal & pelvic ultrasound**
**Diagnostic:**
- Biopsy From organs or pathological masses.
- Aspiration of fluid to detect its nature.
**Therapeutic:**
- Tube drain Such as of postoperative collections.
- Tumor ablation US guided techniques.
112
Diagnostic use of **Neck ultrasound**
Examination of Neck organs as:
* Thyroid.
* Parotid gland.
* Submandibular gland.
* LNs.
As regard (size - echogenicity - masses)
TIRADS for thyroid.
Evaluation of neck vessels:
* Carotid system.
* Internal jugular veins.
113
Interventional use of **Neck ultrasound**
**Diagnostic:**
- Biopsy From organs or pathological masses (FNAC or True cut needle biopsy).
114
what is the 1st choice in cases of?
- Patients with palpable Masses & nipple discharge.
- Screening of breast masses in young female < 35 y
- Breast ultrasound
115
Diagnostic uses of **Breast Ultrasound**
116
Interventional use of **Breast Ultrasound**
**Diagnostic**
- Biopsy From masses (FNAC or True cut needle biopsy).
- Surgical clips.
- Charcoal injection.
117
what is the 1st choice in cases of?
- Nonpalpable testis in pediatric.
- Acute testicular pain.
- Scrotal swelling.
- Testicular ultrasound
118
Diagnostic uses of **Testicular ultrasound**
119
Diagnostic uses of **Vascular ultrasound**
120
How is **Vascular ultrasound** done?
Doppler US
121
Diagnostic uses of **Transfontanellar ultrasound**
122
Diagnostic uses of **Axillary &inguinal ultrasound**
Examination of LNs as regard:
* Size & shape.
* Echogenicity.
* Suspicious criteria.
Evaluation of vessels: Arterial system veins.
Evaluation of any abnormal newly developed swelling & characterization of its nature.
123
Interventional uses of **Axillary &inguinal ultrasound**
**Diagnostic:**
- Biopsy from pathological masses (FNAC or True cut needle biopsy).
124
Diagnostic uses of **Musculoskeletal ultrasound**
**JOINTS:**
- Examination of joints mainly searching for joint effusion.
- Examination of hip joints in newborns (<6 months) Suspected having subluxation or dislocation.
**TENDONS & MUSCLES:**
- Evaluation of tendons & muscles in patients with Sport injury & suspecting tendon pathology.
125
Interventional uses of **Musculoskeletal ultrasound**
**Diagnostic:**
- Biopsy from pathological masses (FNAC or True cut needle biopsy).
- Aspiration From joint effusion or soft tissue collections to detect its nature.
126
Diagnostic uses of **Chest ultrasound**
- Detection of pleural effusion.
- Diagnostic tool & follow up in pneumonic consolidation in Pediatric.
127
Interventional uses of **Chest ultrasound**
**Diagnostic:**
- Biopsy from pathological masses.
- Fluid aspiration to detect its nature.
**Therapeutic:**
- Tube drainage.
128
Diagnostic uses of **Cardiac ultrasound (ECHO)**
- Diagnosis of pericardial effusion.
- Evaluation of cardiac Chamber as regard:
. Size.
. Wall thickness.
. Contractility & Ejection fraction.
- Evaluation of cardiac valves as regard:
. Patency.
. Function.
129
Advantages of **US**
130
Disadvantages of **US**
131
Def of **CT**
132
Principle of **CT**
133
Steps of **CT**
134
Findings in **CT**
135
Uses of **CT Scan**
136
what is the most commonly performed CT scan?
Brain CT
137
Definition of **Iodinated Contrast Media**
- Contrast agents that contain lodine atoms used for x-ray-based imaging modalities such as computed tomography (CT).
138
CI of **Iodinated Contrast Media**
139
Percentage of allergic like reactions to **Iodinated Contrast Media**
0.6% of cases.
140
Are patients who suffer from allergic reactions to shellfish or topical iodine at any higher risk of contrast allergy than patients with any other allergy or asthma?
No
141
Uses of Brain CT
142
Uses of Paranasal CT
143
Uses of Chest CT
144
Uses of Abdomen & Pelcis CT
145
Def of **MRI**
146
Principle of **MRI**
- Works by magnetism (very high magnetic field).
147
what is **Tesla**?
**Tesla (The unite of magnetic flux density)**
- It represents the strength of a magnetic field.
1 Tesla = 20 thousand times earth's magnetic field
148
Types of **MRI** machine
149
Magnetic field strength in **MRI**
150
CI of **MRI**
Contraindicated in patients with:
- Metallic prosthesis.
- Aneurysm clips.
- Cardiac pacemakers.
- Cochlear implants.
- Metallic foreign bodies in the orbits.
151
what are New implants (As pacemaker, Aneurysm clips, etc...) now made from?
- MRI compatible alloys possess no magnetic properties.
- So the patient can be safely introduced in the machine.
152
Advantages of **MRI**
153
Disadvantages of **MRI**
154
Clinical applications in **MRI**
155
Basic sequences in **MRI**
They are 3:
- T1 weighted (+Contrast).
- T2 weighted.
- Proton weighted.
156
Characters of basic sequences in **MRI**
- Very high resolution.
- Sometimes very slow (generally slower than CT), One sequence may take 2 minutes on the best machine.
- So not suitable for dynamic contrast exams because they take too long time.
**To overcome this problem, we use gradient sequence**
157
Acc to the mobility the amount of H+ in the tissue
**(MRI)**
158
How is fat Good & Bad in **MRI**? and How is thsi problem overcomed?
159
what are other sequences in **MRI**?
160
Def of **Inversion Recovery Sequences**
- Sequences used to null the signal from certain tissues.
161
what do **Inversion Recovery Sequences** include?
**FLAIR:** Used to null fluid (like T2 but with hypointense fluid).
**STIR:** Used to null Fat.
162
Characters of **Gradient Echo**
- Can be T1 or T2 weighted.
- Very fast
163
Importance of **Heavy T2-Weighted Images**
164
Uses of **Gradient Echo**
- Can be used in dynamic examinations.
- For example Dynamic liver exam → similar to Triphasic CT.
165
Examples of **Heavy T2-Weighted Images**
MRCP
166
What is **Diffusion Weighted Imaging** based on?
- based on: Measurement of the Random motion of water molecules in the inter cellular space "extracellular fluid" (Brownian movement).
167
Types of water motion
**Directed motion**
- Motion in certain direction as blood in blood vessel.
**Random motion**
- Motion in any direction as in extra & intra cellular fluid.
168
Findings in **Diffusion Weighted Imaging**
169
Principle of **advanced-MRS Spectroscopy**
170
Def of **Advanced MRI Perfusion**
171
Example of **Advanced MRI Perfusion**
Blood Flow Map
172
summary of radiology
173
Summary of x-ray
174
summary of US
175
Principle of CT
176
Summary of MRI
177
Compare between X-Ray, US, CT & MRI in terms of:
- Advantages
- Disadvantages
- Uses
178
what are radiology subspecialities?
1. Emergency Radiology.
2. Cardiovascular Radiology.
3. Head & Neck Radiology.
4. Breast Imaging.
5. Chest imaging.
6. Neuroradiology.
7. Interventional Radiology.
8. Pediatric Radiology.
9. Musculoskeletal Radiology.
10. Nuclear Radiology.
179
Def of **Triphasic CT**
180
If youneed to examine ....., then use .......
181
Case scenario
70-years old female falling on outstretched hands, coming to the ER by pain, swelling & deformity of the right wrist joint.
182
Case scenario
65-years old male developed Sudden deterioration & altered conscious state.
183
Case scenario
35-years old female with neck swelling & normal thyroid profile
184
Case scenario
75-years old male suffers from left temporal seizures.
185
Case scenario
50-years old male suffer from fever & dry cough 4 days ago.
186
Case scenario
39-years old female suffers right hypochondrial pain & fever.
187
Case Scenario
40-years old male with severe pain, abdominal distension & vomiting
188
Case scenario
55-years old male with abdominal pain, jaundice, & abnormal liver function.
189
Case scenario
40-years old male with right flank pain.
190
Case scenario
20-years old foot player with twist injury.
