Radiology Review Flashcards
What are the different image modalities?
X-ray CT MRI US Nuc Med
Which modality uses a single pulse of ionizing radiation?
X-ray
X-ray is good for? bad for?
Good-Bones and airspaces
Bad-Soft tissue and overlapping structures
X-ray film starts what color?
White
After being hit with ionizing radiation, x-ray turns what?
dark
What are the five basic radiographic densities?
Air (darkest) Fat (less dark) Fluid/blood/soft tissue (gray) Bone (white) Metal/contrast (most white)
Because x-rays are two dimensional views of a three dimensional object it is important to get what?
multiple views
What are the x-ray views?
Anteroposterior (AP)
Lateral (LAT)
Oblique (OBL)
Posteroanterior (PA)
Anteroposterior is for what?
Used for patients unable to stand or sit
Is the PA or AP view higher quality?
PA
Which view magnifies the heart and makes borders fuzzy when doing a chest x-ray?
AP
Which x-ray view is usually taken in conjunction with PA view and gives three dimension to objects?
Lateral
Oblique is at an angle and mostly used on what body parts?
limbs
Which modality uses multiple pulses of ionizing radiation?
CT
CT is good for? bad for?
Good- Bone, airspace, some soft tissue and overlapping structures
Bad-Some soft tissues, nerves, muscles, connective tissues
What are the CT Views?
Sagittal or median
coronal
axial or transverse or cross-sectional
MRI uses what to image?
electromagnetism and radio frequency
MRI is good for? bad for?
Good- Soft tissue(nerves, muscles, connective tissue, brain and joints)
Bad-People who cannot hold still or have ferrous metals in the body
what are the views of MRI?
same as CT
What modality uses sound waves and does not use radiation?
US
US is good for? bad for?
Good-determine fluid vs solid, abdominopelvic, blood flow (doppler)
Bad-Things under bones and air filled chambers, deep objects
What are the US views?
Longitudinal (sagittal)
Transverse (axial)
Which modality is used with a radioactive agent and participates in the physiologic processes?
Nuclear Medicine
Nuc med is good for? bad for?
Good-Detecting normal or abnormal physiologic process
Bad-Showing less anatomic detail
What is the pre-read criteria for a film?
Correct patient correct date correct body part correct type number of views expected do comparison films exist
What is the RIP technique for?
Assessing technical adequacy
What is the RIP criteria?
Rotation
Inspiration
Penetration
What is looked for under rotation in the RIP technique?
Clavicles relative to vertebral column and equally spaced
What is examined on inspiration of the RIP technique?
Rib count is 9-10
What is looked for in penetration using the RIP technique?
See ribs through heart
barely see spine through heart
see pulmonary vessels near the edges of the lungs
What is happening if a film shows lung fields almost completely black or a lung field (one or both) shows black with changes in pulmonary vessels?
Over-penetrated film
*over-penetration of one side could suggest pneumothorax
When soft tissue structures are obscured or image appears bright what happened?
under-penetration
In a lung fields with some brighter areas (unilateral or bilat) and no evidence of under penetration, indicating consolidation. You could suspect what diagnosis?
pneumonia
What are the broad steps to reading a chest x-ray?
Pre-read
RIP technique
ABCDE method
What are the broad steps to reading a chest x-ray?
Pre-read
RIP technique
ABCDE method
What is the systematic method (ABCDE) to reading a chest film?
A-airway/airspaces B-bones/soft tissue C-Cardiac shadow D-Diaphragm E-Everything else
What are you looking for in the A of ABCDE? (detail)
Trachea midline and patent
Blood vessels all the way to edges
are there patches of white?
What are you looking for in B of ABCDE? (details)
Clavicle, ribs, pectoral girdle and spine alignment, symmetry and fractures
What are you looking for in C of ABCDE? (details)
Transverse diameter of the silhouette should not exceed 50% of the transverse diameter of the thoracic cage (PA only)
Cardiac borders
What are you looking for in C of ABCDE? (details)
Transverse diameter of the silhouette should not exceed 50% of the transverse diameter of the thoracic cage (PA only)
Cardiac borders
What are you looking for in D of ABCDE? (details)
Diaphragm should be dome shaped right hemidiaphragm is higher or same level as left costophrenic angles (sulcus) - dark and sharp points
What does E for ABCDE include? (details)
Gastric bubble
Check for EKG leads, equipment
Imaging should be ordered to do what?
confirm a suspicion or diagnosis
Examples of common issues in primary care that receive imaging are?
acute foot pain acute ankle pain acute knee pain low back pain HA
Acute ankle pain ottawa rules are?
Pain in malleolar zone
Tenderness to posterior edge (6cm) of lateral/medial malleolus
Inability to bear weight both immediately and four steps at evaluation
Acute foot pain ottawa rules are?
Pain in midfoot
Bone tenderness at the base of the 5th metatarsal or navicular
Inability to bear weight immediately or for four steps in evaluation
What are the steps if suspicion of stress fracture?
X-ray
Bone scan
CT or MRI
Acute knee pain ottawa rules are?
Age >55 tenderness of patella tenderness of head of fibula unable to flex knee 90 degrees Inability to bear weight immediately or for four steps in the evaluation
If you suspect a ligamentous injury, what type of imaging should be used?
MRI
If plain radiographs are negative what should you consider if you still suspect fracture?
CT
What is the criteria to get imaging of shoulder?
Traumatic cause
presence of pain
loss of ROM
Plain films of the shoulder should be able to identify what?
Fracture
Dislocation
Arthritis
AC or SC joint injuries
Tuft fractures refer to fractures involving what?
head of distal phalanx
What is a complex synovial joint formed by the articulations of the humerus, the radius and the ulna?
The elbow
What are the three articulations of the elbow?
radiohumeral -capitellum of the humeus with the radial head
ulnohumeral -trochlea of the humerus with the trochlear notch of the ulna
radioulnar -radial head with the radial notch of the ulna
The presence of a joint effusion in adults on a elbow film should be treated as?
non-displaced radial head fracture
What is the term for an elevated fat pad due to fluid in the joint capsule raising the pad?
sail sign
Dislocations of the elbow are named how?
the direction the radius and ulna are in relation to the humerus
The UCL and lateral epicondylitis would be best assessed using what imaging modality?
MRI
Imaging of the back is generally not indicated for how long?
4-6 weeks
Imaging of the back is indicated if a patient presents with what?
Neuro findings/cauda equina Constitutional findings traumatic cause current/history of malignancy Elderly (>50yo) Infectious risk chronic steroid use nerve root irritation post conservative management risk of osteoporosis
Imaging of the head should be considered if a patient presents with?
head/neck trauma headache(new, worse, abrupt onset) Focal neuro sxs thunderclap HA radiating to neck positional HA temporal HA > 55 yo suspect infection
What is the preferred imaging for trauma to rule out hemorrhage, bone abnormalities or prior lumbar puntcures?
CT
What is preferred imaging for soft tissues such as tumors or vascular?
MRI
What are the common fractures?
Oblique Transverse Spiral Overriding Distraction Torus Greenstick Comminuted
what fractures has an angulated fracture line?
oblique
what fracture runs perpendicular to the shaft of the bone?
transverse
what fracture has a multiplanar and complex fracture line?
spiral
what fracture has one bone displaced over another?
overriding
what fracture has fragments separated by a gap?
distraction
what fracture looks like a bump and is classified as an incomplete fracture in children?
torus
what fracture is bending and is an incomplete fracture seen in children?
greenstick
What fractures have more than two fracture fragments?
comminuted
