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CLIN MED > Radiology > Flashcards

Radiology Flashcards

1
Q

What is an “X-ray ”?

A

Very short, penetrating electromagnetic waves (short, but varied wave lengths)

Used medically for image production & therapy

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2
Q

Type of radition in x rays

A

ioninzing radiation : that’s why they are dangerous.

faster moving - exposes you to more radiation

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3
Q

Photon

A

Mass less particles that travel at the speed of light and produce electromagnetic radiation. Their wavelength determines their energy.

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4
Q

Nonionizing radiation

def 
what can it cause?
A

has insufficient energy to break up atoms, however; sufficient energy in the form of heat may be produced to cause localized tissue damage.

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5
Q

Ionizing radiation

def 
what can it cause?
A

describes any radiation where the photon carries enough energy to ionize or break up an atom or molecule by removing an electron from its orbit.

Can cause biological changes.
E.g. DNA damage and mutations

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6
Q

Stochastic effects

A

Effects associated with exposures to low levels of radiation exposure over a long period of time

This concept stresses that no level of radiation exposure can be considered to be absolutely safe

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7
Q

T or false : radiation exposure that is not ultraviolet and is not ionizing does not cause significant damage as it is low frequency and is considered safe

A

False :

Stochastic (deterministic) effects
This concept stresses that no level of radiation exposure can be considered to be absolutely safe

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8
Q

Nonstochastic (Deterministic) Effects

A

Effects that are associated with much higher levels of radiation exposure, usually incurred over a much shorter period of time

Sterility changes, radiation burns, cataract formation and damage to; blood forming tissues, GI epithelium and CNS

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9
Q

radiation and pregancy (2)

A

Pregnant women should NOT undergo radiographic imaging unless suffering from serious illness or acute trauma

and cannot be determined by other means, especially sonography

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10
Q

ALARA Principle

A

As Low As Reasonably Achievable

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11
Q

How to minimize patient exposire to x rays (7)

A 
Minimizing exposure time
Maximizing distance from the tube
Lead protection (thyroid, gonads)
Using intensifying screens
Modern equipment
Collimate (restrict beam of X-rays to a smaller area)
Avoid re-takes!!
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12
Q

How to minimize worker’s exposire to x rays (2)

A 
Dosimeter Badges (measures exposure)
Protective shielding
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13
Q

How are x rays created? (2)

A

Electrons are accelerated across a tube & impact a target

The x-ray beam is emitted from the target; it is shaped like a cone of diverging rays

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14
Q

what helps restrict the beams?

A

Collimators (shutters) on the tube housing help restrict the beam to the anatomical area of interest

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15
Q

what do speeds on xray cassettes do? 2

A

Effects radiation dose

Effects detail on films

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16
Q

What is a Radiograph

A

x ray

Created by variable amounts of beam attenuation
Attenuation is the process by which radiation loses its power as it travels through matter due to absorption or scattering of the beam

Structures of different densities become superimposed on one another on the image

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17
Q

How do dense materials look on a radiograph

A

DENSE materials attenuate the x-ray beam, resulting in less film exposure
METAL vs AIR

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18
Q

CROSS TRIANGULATE - what does it mean?

A

When ordering x-rays it is almost always necessary

to take 2 views at right angles to one another

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19
Q

Radiographer

A

X-ray Technician):
Takes radiographs & other imaging
Not a physician
Not trained to interpret radiographs

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20
Q

Radiologist

A

Interprets radiographs & other imaging

Physician with post-graduate education

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21
Q

what is KUB?

A

Kidney Urinary Bladder

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22
Q

Plain film radiographs examples

A 
bone tumors ( always start plain)
trauma and arthritis ( often the only imagine required)
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23
Q

What cannot be seen on plain films? 8

A 
Details of Soft Tissue structures
IVD herniations
Specific muscles (usually)
Ligaments and tendons (usually)
Neuroanatomy details
Vessels
Many abdominal viscera
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24
Q

What are imaging guidleines for elderly ( over 65?)

A

CURRENT IMAGING GUIDELINES RECOMMEND MORE LIBERAL USE OF IMAGING AFTER AGE 65

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25
Q

Conditions that we use liberal imaging. Why? (5)

A 
PRIMARY OSTEOPOROSIS
DRUGS AFFECTING BONE DENSITY
MALIGNANT BONE TUMOURS
IMPORTANT ASYMPTOMATIC CONDITIONS:
AAA (abdominal aortic aneurysm), PAGET’S, SOFT TISSUE ABNORMALITIES, ETC. 
DEGENERATIVE ARTHRITIDES

In older patients. risk less than reward

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26
Q

Low Back pain that cannot be seen on plain films of x-rays (3)

A

Muscle strains
Ligamentous sprains
Disc herniations

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27
Q

5 densities in order of density.

what colour are they?

A

Air, fat, water, bone, metal

least dense = air, more translucent (therfore more black)
most dense = metal, more white and opaque

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28
Q

Normal chest vs. normal rib technique. what do you see?

A

A. Normal Chest Technique: allowing you to see heart, pulmonary vessels, and skeletal structures
B. Normal Rib Technique: pulmonary vessels become much harder to see, and the bones become easier to see

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29
Q

Peterson’s Rules (3)

A

Of the same patient?
Taken the same date?
Of the same anatomy?

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30
Q

what biological condition can hinder x ray imaging? why?

how to mitigate this?

A

obesity - causes poor penetration of underlying structures ie lung tissue

using a higher film speed

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31
Q

Search Pattern

ABC’S

A 
Alignment:  
(dislocations, subluxations, curves)
Bone:
 (Size, shape, density, correct number of bones, cortex intact)
Cartilage (Joints)
Soft Tissues
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32
Q

A in ABC’S

A

Alignment

  1. Normal curves
    - Spine
  2. Normal angles
    - E.g. Genu varus and valgus in the knee
  3. Normal joint alignment
    - Subluxations (dysfunction of a joint), dislocations
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33
Q

Subluxations ?

A

Subluxations (dysfunction of a joint),

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34
Q

B in ABC’s

q’s to ask 6

A

Bone

Normal shape?
Normal size?
Normal density?
Cortex intact?
Medullary space?
Correct number of bones?
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35
Q

C in ABC’s

3 q’s

A

Cartilage (joints)

Normal joint space width?
No loose bodies?
Articular cortex?

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36
Q

S in ABC’s

4 q’s

A

S = soft tissue

Normal density
Normal size
Normal contour
Swelling?  Mass?
Calcifications?
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37
Q

CATBITES

What?

A

Categories of Bone Disease:

Congenital
Arthritides
Trauma
Blood (Vascular)
Infectious
Tumour (Neoplastic)
Endocrine/Metabolic
Soft Tissue

When you see something that is not normal on a film, these categories give you a good checklist of things to consider in making the correct diagnosis

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38
Q

Tomography

what? advantages? 2 disadvantages? 3

A

Involves visualizing a selected anatomical layer

X-Ray tube moves in one direction while the cassette and film move in the opposite direction which produces a sharp in-focus image while structures above and below are blurred

Advantages: subtle fractures or early bone destruction identified before they appear on plain films

Disadvantages: Higher radiation dose, longer exposure times create motion artefacts and enough slices need to be obtained

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39
Q

CT: Computed Tomography

what?

A

Radiographic tube within a Gantry that emits a thin x-ray beam as it rotates 360° around the patient while information evaluated by computer formulates a transverse image of the slice

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40
Q

Should we do an abdominal CT?

A

Ultrasound is a more cost effective/non-invasive method for obtaining the same information

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41
Q

Contraindications and Disadvantages of CT (7)

A

Very few
Hypersensitivities to iodinated dyes
Higher radiation dose (3 – 5 rads compared to lumbar spine x-ray of 100 mrads)
Pregnancy
CT of children
Presence of metallic objects near area of interest may result in image artefact from beam scattering
Better detail may be obtained with MRI in some instances
Some patients may be claustrophobic

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42
Q

Bone Windows

how do they appear?

A

Window level and width that optimizes the attenuation values of bone. The attenuation coefficients of soft tissue have a dark grey appearance.

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43
Q

Soft Tissue Windows

what distinguishment can we not make?

A

Window level and width that optimizes the attenuation values of soft tissues. Differentiation of cortical or medullary bone is not possible with this setting.

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44
Q

MRI (Magnetic Resonance Imaging)

A

Image production is the result of a complex process involving the interaction of hydrogen protons with an external magnetic field

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45
Q

What is the correct order of this sequence for MRI?

  1. Normal random proton alignment that without the influence of an external magnetic field allow them to be in constant motion
  2. When the RF pulse is removed, a coil detects the energy transferred from the realignment of the protons to their equilibrium position which produces the image
  3. Radiofrequency pulse is applied, the H protons are excited to a higher energy state by altering their orientation
  4. Protons align due to strong magnetic field produced by an electromagnet housed in the MRI gantry
A

1, 4, 3, 2

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46
Q

MRI Generals

4

A

No Ionizing radiation
Images directly in any plane
Images larger sections of the body
No dangerous contrast agents required

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47
Q

What do we use in MRI instead of dangerous contrast agents?

A

Intravenous or intra-articular contrast sometimes used

Gadolinium & saline mixture

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48
Q

CNS? which modality do we want to use?

A

CT unless its acute

49
Q

which modality do we want to use for boney detail?

A

CT

50
Q

CI for MRI 3

A

Anything metallic
(Can draw them out of the body)

1st trimester – just because they don’t know

Welders ( shards in eye)

51
Q

Fat image

A

T1

in MRI

Structures containing fat (bone, subcutaneous fat) appear bright. Structures containing water (CSF, edema, neoplasm, inflammation) appear dark

52
Q

Water Image

A

T2

in MRI

Structures containing predominantly free water (neoplasms, edema, inflammation, nucleus pulposus, CSF) appear bright. Tightly bound water (ligaments, menisci, tendons) appear dark

53
Q

Advantages of MRI 5

A 
1. Excellent detail
Superb soft tissue differentiation
2. Can image large sections
3. Multiplanar imaging capabilities
4. No ionizing radiation 
5. Contrast (if used) is not dangerous – compared to ionidated
54
Q

Limitations of MRI 3

A
  1. Stay very still for 45-50 minutes
  2. Inferior to CT in detecting an acute hemorrhage
  3. Inferior to CT for boney injury
55
Q

Arthrography

what is it?
what is it used for? (4)
disadvantages? (5)

A

Dye injected into joint
Plain radiographs taken

Helps identify intra-articular derangements of menisci, cartilage, ligamentous and synovial abnormalities

disadvantages : invasive, interpreter dependency, and possible oversight of small lesions, risk of infection (MAIN), adverse reaction to dye

56
Q

CT Arthrogram

when is it used?

A

Useful when there is metal in the region which limits effectiveness of MRI, or when the patient has a contraindication for MRI

57
Q

MRI Arthrogram

A

useful in detecting precise images. cannot use if CI

58
Q

Myelography

what is it? (2)

Advantages

Disadvantages

Complications

A

Iodinated, water- based contrast injected into the subarachnoid space at L2 or L3 level
Aids in disc, vertebral canal and nerve root disease

Advantages: useful in determining multi-level spinal stenosis and injury at the junction of the nerve root and cord

Disadvantages: invasive procedure that risks infection, nerve root damage or dural tears.

Complications include Headaches, Arachnoiditis (inflammation of arachnoid mater).
Postmyelogram headaches encountered 40% of cases
Sometimes used when patients too large for CT or MRI.

59
Q

Arteriograms (Angiography)

what ?
how?
what purpose?

A

Iodine based dye injected

Often use femoral artery approach
Done with Fluoroscopy (motion images)

Cardiac catheterization is one of most common procedures
Cerebral angiograms also common

WP: Any vessel can be visualized

60
Q

Coronary Angiography

what?
how?
why?

A

The “gold standard” for coronary artery disease

Catheter fed via Femoral artery

Contrast injected into coronary artery

For diagnosing the impact of heart attack and making heart activity visible

61
Q

Angioplasty

A

While doing an Coronary Angiography

While they are in there” the decision to open a vessel and place a stent may be made

62
Q

MR Coronary Angiography

what?
risks?
Where?

A

Useful in detection of stenosis in large coronary vessels, but not small branches
Risks: Same as any MRI procedure

Normal right coronary artery

63
Q

Best way to See cardiac enlargement?

A

Can’t see on CXR (xray)

ECG/EKG better - not an imaging modality

64
Q

Barium Studies: General

A

Performed & evaluated under fluoroscopy

study of the bowel

types of barium studies

65
Q

types of barium studies (5)

A

Barium Swallow—evaluates esophagus
Barium Meal—evaluates stomach
Barium Meal/Follow-through—small intestine
Small bowel enema—barium injected into duodenum via a tube through nose
Barium Enema/Lower GI
Barium injected into rectum, sigmoid, large bowel up to ileocecal valve

66
Q

Barium Swallow

A

—evaluates esophagus

67
Q

Barium Meal

A

—evaluates stomach

68
Q

Barium Meal

A

/Follow-through—small intestine

69
Q

Barium Enema

A

Lower GI

70
Q

Barium injected

A

into rectum, sigmoid, large bowel up to ileocecal valve

71
Q

Patient Prep for Barium Study

A

Clear liquid diet before exam ( lower GI)

Upper GI - nothing to eat for 8 hours

72
Q

Does Fluoroscopy use x rays?

A

yes

73
Q

CI for barium studies

A

Barium by itself is an inert substance and completely harmless
However if it escapes into the abdominal or thoracic cavity through a perforation, it can cause severe inflammation
Thus barium studies should not be done in patients with suspected perforation
Water-soluble contrast material is used if perforation is suspected

74
Q

Excretory Urography (IVP or IVU)

what?

A

The most basic radiographic study of the urinary tract (vascular delivery of contrast material)

Allows visualization of the renal collecting systems, ureters, and bladder for obstruction

75
Q

How Is An IVP Performed (4)

A
  1. Radiopaque dye is injected (after a scout KUB) into a patient’s bloodstream
  2. Radiographs are taken
    - as the dye is concentrated in the kidneys, and passed down the ureters to the bladder
  3. A compression band
    - may be applied to compress the ureters and keep dye in the area of the kidneys for longer, which improves image quality
  4. Serial films are obtained over 15 to 30 min.
    - Serial films are obtained over 15 to 30 min.
76
Q

Adverse Reactions To Contrast Material

A

Minor reactions are the most common
Seen in 5-10% with iodinated contrast
Urticaria, itching, nausea, vomiting = m/c
Non-iodinated agents can be used

77
Q

RETROGRADE PYELOGRAM

what is it?

when can you use it?

A

Ureteral Catheter
Non-vascular delivery of contrast material

Normal renal function is not necessary for visualization

78
Q

Diagnostic Ultrasound

aka?
what?
CI?

A

Uses Sound waves
AKA ‘sonogram’

no known CI or side effects

79
Q

What is a diagnostic ultrasound good for? 6

A 
Obstetrics (hip dysplasia)
Abdominal and pelvic masses/cysts
Heart (echocardiography)
Breast imaging (cysts)
Some musculoskeletal tendons, ligaments if peripheral in location (rotator cuff)
Not good for bones and bowel
80
Q

Advantages of ultrasound (3)

A

non-invasive, does not involve ionizing radiation, useful in visualizing soft tissue adjacent to joints

81
Q

Disadvantages of ultrasound 2

A

Disadvantages: tissues too close to bone not visualized, metal implants inhibit detail of nearby soft tissues

82
Q

How does ultrasound work?

what does it identify? 4

A

As a controlled sound bounces against objects, its echoing waves can be used to identify:

How far away the object is
How large the object is
The object’s shape
The object’s internal consistency (fluid, solid, mixed) and how uniform it is

83
Q

Which imaging modality do you see in real time and can see movements of organs

A

Ultrasound

84
Q

What is the doppler - how can you see it?

A

Evalute blood flow, clots etc.

Ultrasound

85
Q

Proceedure of ultrasound (3)

A 
Gel Applied
Transducer Applied 
Creates and records sound waves
Significant pressure may cause discomfort, especially if bladder full
Produces live computer image
86
Q

Which modalities are best for showing kidney stones but not gallstones

how do you see gallstones?

A

CT kidney stones

ultrasound - gallstones

87
Q

Which modalities are best for showing kidney stones but not gallstones

how do you see gallstones?

A

CT kidney stones

ultrasound - gallstones

88
Q

Echocardiogram

aka

what? (5)

A

AKA - ultrasounds

Evaluates pumping and valve function 
Motion image of the heart
Detects flow and velocity of the blood
Primarily used to evaluate murmurs
Also used to evaluate location and extent of MI, valves dysfunction, clots, congenital heart defects and pericardium
89
Q

Echocardiography

Benefits? 3

A

aka - heart ultrasound

No contrast agents used
Non toxic, non-invasive
No side effects

90
Q

Doppler Ultrasound

what?
example conditions it can help diagnose (3)

A

Measures blood flow by measuring the rate of change in its pitch

May help diagnose many conditions, including:
blood clots, poorly functioning valves in veins, heart valve defects

91
Q

How is colour produced on a Doppler ultrasound?

A

the amount of energy

92
Q

What is Mitral regurgitation?

A

imposes a chronic overload on the left ventricle

93
Q

What is nuclear medicine? short 2

examples 2

A

Relatively non-invasive

Uses radiopharmaceuticals to evaluate pathophysiologic abnormalities of various organ systems

aka tumors, fractures etc.

94
Q

what vector do we use in nuclear medicine?

A

A radionuclide, given intravenously, can be chemically tagged to these substances from increased phsyological function

95
Q

Radioactive pharmaceutical

A

aka a radionuclide - tagged to something we metabolize – localized in somewhere with high metabolic activity : fracture, tumours,

96
Q

what does nuclear medicine not look at? or emphasize less

A

Doesn’t look at things anatomically but rather helps us understand the function – physiology

looks at both to diagnose and treat

97
Q

How nuclear medicine works?

A

IV injection of radioactive material

need a detector - gamma camera

98
Q

Scintigraphy

what does it do? (3)

what do we look for? (2)

what does it diagnose/not diagnose? (2)

A

aka - bone scan

IV injection of radioactive nuclide that emits gamma rays which Scintillate (sparkle)

very sensitive not specific

what do we look for?

  • high osteoblastic activity
  • uniform distribution of Radionuclide

what does it diagnose/not diagnose?
Not for osteoporosis
Measures increased physiology – fractures etc.

99
Q

How is Nuclear Medicine Different from CT, US & MRI

exceptions (2)

A

In General:
CT, US, MRI provide anatomical or structural information

Nuclear imaging provides functional data

Some Exceptions:
Colour Doppler (looks at blood flow)
Functional MRI (detects neural function)
100
Q

How is Nuclear Medicine Different from CT, US & MRI

exceptions (2)

A

In General:
CT, US, MRI provide anatomical or structural information

Nuclear imaging provides functional data

Some Exceptions:
Colour Doppler (looks at blood flow)
Functional MRI (detects neural function)
101
Q

Hot spot in Scintigraphy

chief applications (3)

A

area of increased uptake - higher metabolism

Detection of metastasis
Detection of osteomyelitis (infection)
Can also detect fractures and inflammation

102
Q

Cold spot in Scintigraphy

A

Area of decreased metabolism (less than normal)

“Cold Spot”

103
Q

Types of Nuclear Medicine Scan (7)

A 
Bone Scan
PET
SPECT
Cardiovascular Imaging
Lung Scan 
Ventilation and perfusion or V/Q scans 
Renal Scan
Thyroid Scan
104
Q

Bone scan generals

aka

sensivity? specificity?

what can it diagnose/not?

A

in nuclear medicine
SCINTIGRAPHY

VERY SENSITIVE to a wide variety of diseases
Can detect 3-5% bone loss
X-ray requires 30-50% bone loss before we detect it
VERY LIMITED SPECIFICITY
“Clinical correlation is required”

Bone scan – osteomyelitis ( serious pathological processes ) not osteopersosis

105
Q

What does the patien need to do to prepr for a SCINTIGRAPHY?

A

void before and after image acquisition

Radionuclide is eliminated in urine and stool

Inject radionuclide

106
Q

Risk of Nuclear MEdicine Scan (2)

A

Severe reactions to injections of radiopharmaceuticals are rare

Radiation dose is LOW compared to other studies that use ionizing radiation (xray)
Dose depends on the scan, and the quantity of radionuclide used

107
Q

SPECT

what?
in contrast to?

advantages

application

A

in nuclear medicine

slices of physiological activity

in contrast to : CT

Compared to PET, SPECT is less expensive, and centres are more accessible but they produce images with less resolution

localized internal organ function by showing how blood flows to tissues and organs. 
class ex)  dementia
108
Q

Special notes about SPECT and MSK (3)

A

In the MSK system, SPECT is like bone scan and CT combined

Can produce a bone scan that looks at a specific plane in the body
Thus, can look at specific anatomical site

109
Q

PET “ Position Emission Tomography”

what? (3)
How? 1

A

nuclear medicine image technique
3d images of the functional processes for the body
give anatomy and phys on the same image

inject radionuclide - produced in a cyclotron (special machine, very expensive, and limited availability)

we see hot spots where there are tumors etc.

110
Q

Uses of PET (6)

A

” Position Emission Tomography”

clinical oncology
detection of metastasis 
brain pathology
planning 
evaluation of treatment

not a first line imagine proceedure

111
Q

Limitations of PET

A

EXPENSIVE
“ Position Emission Tomography”

LIMITED Availability
Centres must have a cyclotron
Poor detail of anatomy, thus used IN COMBINATION with other imaging modalities (CT and MRI, most commonly)

112
Q

Mammography (3)

what are the ulternatives?

A

X-ray examination of the breasts for detection of tumors

Takes approximately 30-45 minutes
Advise your patient: powder, lotion, perfume or deodorant can produce shadows on the mammogram

Alternatives:
US is typically used for further evaluation of masses found on mammography or palpable masses not seen on mammograms

MRI useful to evaluate questionable findings pre-surgical evaluation in patients with known breast cancer to detect

113
Q

Bone Density Assessment (2)

A

DEXA scans (Dual Energy X-ray Absorptiometry)diagnostic measure of choice for osteoporosis

114
Q

What is DEXA?

A

used in bone density assessment : fast, low radiation

measures Skeletal size, body composition and even software may distort result (over/underestimate density)

115
Q

T score

A

Bone density assessment

The number of standard deviations away from the mean. The mean is derived from the age of peak bone mass (20 – 35 years).

-2.5 or worse constitute osteoperosis
each SD doubles risk of fracture and 10-15% loss of bone

less than -1 but greater than -2.5 = osteopenia (lower than normal)

Normal is -1

116
Q

Z score

A

bone mineral density compared to the mean of an age matched population. Its usefulness has been questioned and is not recognized for quantifying osteoporosis

117
Q

In bone density assessment , which body parts should be imaged? (3)

A

Hip and Lumbar Spine
Lots of trabecular bone
DEXA of femoral neck predicted hip fracture better than measurements at other sites

Calcaneus
Strong correlation with femoral neck density and future fracture risk
Radius

A Physician may not be able to assess whether a pt. with a low T-score at hand or forearm has substantial bone loss at other sites

118
Q

what is a bone scan : layperson and what do we know?

A

Layperson : just a bone density test

we know that it is nuclear medicine

CLIN MED (5 decks)

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