Theory Review( not on test one) Flashcards
Calcium Homeostasis
-a healthy body has a balance btw amount of calcium stored in the bones, calcium in the blood and excess calcium excreted by kidneys
-controlled by the endocrine system
-calcitonin and parathormone control calcium concentration in our bodies
Bone composition
-two types of bone: compact or cortical and spongy( cancellous) or trabecular bone
-compact bone is dense and strong
-cancellous bone has many open spaces giving it a spongy appearance
osteoporosis
loss of spongy or cancellous bone and thinning of cortical bone
risk factors fro low bone mass
female
advanced age
family history
ethnicity
low body weight
lifestyle
estrogen deficiency
calcium or Vit D deficiencies
sedentary lifestyle
alcohol abuse
tobacco abuse
What is BMD
a test used to assess the amount of minerals like calcium in your bones
-the test determines whether or not you have or are more likely to develop osteoporosis
-can be used to monitor osteoporosis treatment
indications for osteoporosis assessment
fracture with minor trauma
kyphosis
height loss
protruding abdomen
reduced pulmonary capacity
esophageal reflux
fragility fracture
-break occurs due to low impact activity
-happens b/c bones are weak
-joints usually affected include: spine(compression fracture), hip, wrist(collet from falling)
Purpose of BMD
-measure BMD
-detect bone loss
-establish the diagnosis of osteoporosis
-assess an individuals risk for fracture
-assess a patients response to therapy
-perform vertebral fracture assessment
BMD equipment
-Dual energy Xray absorptiometry( DEXA)
-uses two different xray beams with different energies to estimate bone density
-strong dense bone=less xray beam passes through
-peripheral dual-energy absorptiometry measure bone density in wrist, heel, finger
-QCT, QUS
T score
-compares patients BMD to the BMD of a young healthy adult of same sex
-osteoporosis is a T score of -.25 or 25% lower than the average 30 year old
-osteopenia-T score btw -1.0 and -2.5 below normal
T score -1 and above=normal bone density
T score -1 and -2.5=bone density below normal, may lead to osteoporosis
T score -2.5 and below=osteoporosis
Z score
-compares your bone density to average bone density of people your age and gender
-A z score of more than 2 standard deviations below others your age there may be medical conditions or medications that are causing low bone density
Z score above 2.0=normal
BMD radiation safety
-tech is in the room
-radiation form BMD is very low
-be at least 2M from the DXA couch
Biliary Tract Procedure
Operative Cholangiography
-doen to loof at gallbladder and cystic duct
-catheter is placed into biliary ducts and injects iodinated CM into the ducts
Operative Cholangiography C arm positioning
patient position- supine
C arm position- centered over right side of abdomen below rib line
structures shown- contrast filled biliary system
Biliary Tract Procedure
Laparoscopic Cholecystectomy
-less invasive approach for removal of gallbladder
-small opening in umbilicus and passes endoscope into abdominal cavity
-diseased gallbladder is removed from small opening
Biliary tract procedure
ERCP(endoscopic Retrograde Cholangiopancreatogrpahy)
-combined endoscopic and fluoroscopic procedure where a endoscope is used to visualize the anatomy and allows for passage of tools into biliary and pancreatic ducts
-xray is used to visualize the ducts through administration of contrast
ERCP clinical indications
-blockage or narrowing of one of the bile ducts
-obstructionmay be caused by gallstones, infection that causes inflammation, strictures or scarring, accumulation of tissue or fluid and non/cancerous tumours
ERCP common symptoms
- persistent abdominal pain not diagnosable by other tests
- jaundice, or yellowing of skin and eyes
- light colored stools or dark urine
- loss of appetite or weight
- confirmed diagnosis of certain cancers in the affected organs
- CT scan showing a stone or mass in the affected organs
urinary system procedure
retrograde urography
-examines urininary system in which contrast is introduced directly retrograde into pelvicalyceal system via cauterization
-performed to determine location of undetected calculi or other obstruction in urinary system
orthopaedic procedures
closed reduction
-fractured bone is manipulated and realigned without surgery
-performed externally using manual technique or traction devices
orthopaedic procedures
open reduction
-surgery performed by orthopaedic surgeons to treat fractures
-internal fixation is physically connecting the bones
-uses screws, plates, wires or nails to align the bones
orthopaedic procedures
External fixation
-pins or wires are inserted into bone percutaneously and held together via external scaffold
-done for severe open fractures, comminuted closed fractures, arthrodesis, infected joints, major alignment and length deficits
orthopaedic procedures
intramedullary fixation
-rods and nails are inserted within the shaft of long bones to stabilize fractures
-popular in humerus, tibia and femur
orthopaedic procedures
hip fractures
-femoral neck fractures
-intertrochanteric fractures
-subtrochanteric fractures
-subcapital fractures
orthopaedic procedures
hip pinning( open reduction with internal fixation)
-non displaced femoral neck fracture is usually treated with hip pining
-surgical pins or screws are passed across the fracture site to hold the ball of the femur in place
-pinning prevents the femoral head from dislodging or slipping off the femoral neck
hip surgery procedure
patient position- supine with legs abducted, affected leg in traction
C arm position- between patients legs, beam centered over affected hip, rotate as needed to demonstrate hardware
-structures shown-prox femur and hip joint, acetabular rim, femoral head and neck, lesser and greater trochanters, hardware
orthopaedic procedures
Total Hip Replacement( total hip Arthroplasty)
-surgical procedure in which the hip joint is replaced by a prothetic implant
-commonly done to relieve arthritic pain
-THA replaces Bothe acetabulum and femoral head
-hemiarthroplasty replaces only femoral head
spinal procedures
laminectomy
-surgical procedure performed to alleviate pain caused by neural impingement
-designed to remove a small portion of the bone or herniated disk material impinging on the nerve root to give the nerve root space
spinal procedures
spinal fusion
-connects two or more vertebra
-bones can’t move which eases neck or back pain
-often part of laminectomy procedure
spina procedures
inter body fusion cages
-titanium cages filled with bone that are inserted between vertebral bodies to maintain disk space height and fuse the joint
Thoracic procedures
pacemaker insertion
-a pacemaker is a medical device that is inserted to maintain a proper heart rhythm when the heart rate drops below a defined level
-leads of pacemaker are placed into one or more chambers of the heart
-C arm is placed over the heart to ensure the leads are properly placed
cardiovascular system functions
-transportation of oxygen, nutrients, hormones and chemicals
-removal of waste products, primarily through kidneys and lungs
-maintenance of body temperature, water and electrolyte balance
cardiovascular system
heart
-central organ of cardiovascular system
-responsible for pumping blood through circulatory system
-has rich supply of blood
-right side has deoxygenated,
-left side has oxygenated blood
herat anatomy
-4 chambers
-upper chambers right and left atria RECEIVE blood
-lower chambers, right and left ventricles PUMP blood OUT the heart
-left ventricle is thickest chamber b/c it pumps blood to entire body
blood vessels
-after blood leaves heart it is pumped through a network of blood vessels to different parts of the body
-ARTERIES-transport oxygen blood from he heart to tissues
-VEINS return deoxygenated blood to the heart
-ARTERIOLES -branch into networks of very small blood vessels called CAPILLARIES
Coronary Veins
-blood returns to right atrium via coronary veins
Coronary Arteries
-coronary circulation supplies blood to the heart itself
-first branches off the aorta: LEFT coronary artery(LCA) and RIGHT coronary artery(RCA)
-LCA supplies blood to both ventricles and left atrium
-RCA supplies blood to right atrium and right ventricle
coronary sinus
large vein with three main branches: Great, Middle< small cardiac veins
3 main branches off aorta
- brachiocephalic artery
2.left common carotid artery
3.left subclavian artery
4 arteries that supply blood to the brain
1.Right common carotid
2.left common carotid
3.right vertebral
4.left vertebral
carotid arteries
-bifurcates into external and internal portions
-EXTERNAL carotid artery carries blood to the face
-INTERNAL carotid artery supplies blood to the cerebral hemisphere of the brain
what do the vertebral arteries branch off of?
subclavian arteries
major branches
-2 main arterial branches come off the internal carotid artery: anterior and middle cerebral arteries
-posterior cerebral artery branches off the basilar artery
Circle of Willis
-left and right internal carotid arteries
-left and right anterior cerebral arteries
-left and right posterior cerebral arteries
-left and right posterior communicating arteries
-basilar artery
-anterior communicating artery
Circle of Willis main function
-provide a collateral blood flow between the anterior and posterior arterial systems of the brain.
-offers the alternate blood flow pathways between the right and leftcerebral hemispheres
-This way the circle protects the brain from ischemia and stroke in cases of vascular obstruction or damage.
major veins of head and neck
internal jugular vein
external jugular vein
vertebral vein
Thoracic Arteries
-two main arteries in the chest are AORTA and PULMONARY arteries
-off the right ventricle the pulmonary arteries supply blood to the lungs with DEOXYGENATED blood
-the aorta coming from the left ventricle RECEIVES OXYGENATED blood to be carried to entire body
Aorta
-extends from the heart to 4 lumbar vertebra and divides into thoracic and abdominal sections
Aorta
what is the Thoracic section subdivided into?
1.aortic bulb(root)
2.ascending aorta
3.aortic arch
4.descending aorta
aorta anatomy
Aorta Bulb or root
-most proximal segment
-coronary arteries come off the aortic root
-from left ventricle aorta rises into the chest were it becomes ascending aorta
Aorta anatomy
ascending aorta
-terminates at around second sternocostal joint and becomes the arch
aorta anatomy
arch of aorta
-three main branches come off the arch: brachiocephalic, left common carotid, left subclavian artery
Thoracic Veins
1.superior vena cava( return deoxygenated blood to right atrium)
2.inferior vena cava(( return deoxygenated blood to right atrium)
3.azygous- carries deoxygenated blood from thorax to SVC
4.pulmonary veins-carry OXYGENATED blood from lungs back to left atrium
aorta anatomy
abdominal aorta
-once thoracic aorta passes diaphragm it becomes abdominal aorta
-sits informs of vertebra
-bifurcates into right and left common iliac arteries at L4
major abdominal aorta branches
1.celiac trunk
2.superior mesenteric artery
3.left renal artery
4.right renal artery
5.inferior mesenteric artery
major abdominal aorta branches
Celiac artery
-has 3 main branches:
1.left gastric(oxygenated blood to stomach and esophagus)
2.splenic
3.common hepatic arteries( supplies blood to liver)
major abdominal aorta branches
Superior Mesenteric Artery(SMA)
-inferior to celiac trunk at L1
-supplies blood to pancreas, most of small intestine, portions of large intestine on right side(cecum, ascending colon,half transverse colon)
major abdominal aorta branches
renal arteries
-branch from abdominal aorta at disk of L1/L2
-right is longer and lower than left
major abdominal aorta branches
inferior mesenteric artery
-originates from aorta at apron L3 about 1 1/4 inches above bifurcation
-supplies blood to portions of large intestine(left half of transverse colon,descending colon,sigmoid colon, most of rectum)
common iliac arteries
-distal portion of abdominal aorta bifurcates at the level of L4 into right and left common iliac arteries
-each divides into internal and external iliac arteries
-INTERNAL iliac artery supplies pelvic organs( bladders ectum, reproductive organs, pelvic muscles)
-EXTERNAL iliac artery supplies lower limbs
Abdominal veins
-blood is retired from structures below diaphragm to right atrium by IVC
-major veins in abdomen are: R and L common iliac, Internal iliac, external iliacs, renal veins, hepatic portal system
-iliac veins drain pelvic area and lower limbs
-renal veins return blood from kidneys
-The superior and inferior mesenteric veins return blood from the small and large intestine through the hepatic portal vein and the hepatic veins and into the IVC
upper limb arteries
-blood supply begins at subclavian artery
-subclavian artery becomes axillary artery and then brachial artery
-brachial artery bifurcates into ulnar and radial arteries
-radial and ulnar arteries join to form two palmar arches that supply fingers and hands with blood
upper limb veins
-cephalic and basilica are primary tributaries of the superficial venous system
-anterior to elbow joint is median cubital vein-most used to draw blood
-arm veins eventually drain into SVC and then into right atrium
lower limb arteries
-begins at external iliac artery and ends at arteries in the foot
-first artery to enter lower. limb is common femoral artery
-common femoral divide into femoral and deep femoral arteries
-femoral artery extends down the leg and becomes popliteal artery at level of the knee
-major branches off the popliteal artery are anterior tibial and posterior tibial arteries
-The anterior tibial artery continues as the dorsalis pedis artery, with branches to the ankle and foot
-The posterior tibial artery supplies the calf and plantar surface of the foot.
lower limb veins
-the superficial veins include great saphenous and small saphenous
-majpr deep veins are posterior tibial, anterior tibial, popliteal and femoral
-anteriro and posterior tibial form popliteal vein
-popliteal veins continues upward to become femoral vein before becoming external iliac vein
angiographic procedures
equipment requirements
-island type table with all four-way floating capability
-C arm with subtraction
-programmable digital image acquisition system
-specialized xray tube with heat load capacity and rapid cooling to meet need of high mA, high Fram rates, and multiple acquisition series
-physiologic monitoring equipment
cerebral angiography
purpose
-provide imaging to localize and diagnose pathology or anomalies of the arteries of the brain and neck
cerebral angiography
clinical indications
-vascular stenosis and occlusions
-aneurysms
-trauma
-arteriovenous malformations
-neoplastic disease
cerebral angiography
common vessels for catheterization
-the common carotid arteries
-internal carotid arteries
-external carotid arteries and
-vertebral arteries
how much contrast is used for cerebral angiography
depends on which vessel is being examined but usually ranges from 5ml to 10ml
cerebral angiography
imaging
-digital C arm and/or flat detector digital fluoroscopy is preferred
-imaging sequence must include all phases of circulation-arterial, capillary, venous
what is the purpose of Thoracic Angiography
study ascending aorta, the arch, the descending portion of thoracic aorta and major branches
purpose of pulmonary arteriography
study pulmonary vessels almost always to investigate for pulmonary embolus
thoracic angiography
clinical indications
aneurysms
congenital abnormalities
vessel stenosis
embolus
trauma
thoracic angiography
catheterization
-perferred puncture site is femoral artery
-catheter is advanced to desired location in thoracic aorta
-femoral vein is used for imaging of pulmonary arteries
-catheter goes through IVC, through right atrium into right ventricle and into pulmonary artery
how much contrast is used in thoracic angiography
between 30-50ml
what is the purpose of Angiocardiography (Coronary Angiography)
imaging of the heart and coronary arteries
-aka cardiac catheterization
-The most common procedures include aortography (aortic root flush), and coronary arteriography (left and right sided).
Angiocardiography
clinical indications
-coronary artery disease and angina
-myocardial infarct
-valvular disease
-atypical chest pain
-congenital heart anomaly
-other heart and aorta pathology
which artery is often used to inject contrast media for Angiocardiography
femoral artery and radial artery are common but risks are lowered using radial artery
Angiocardiography
imaging
-imaging rate for coronary arteries is 15-30 frames/sec
-routinely six views of left coronary artery and two views of right coronary artery are obtained
abdominal angiography clinical indications
aneurysm
congenital abnormality
gastrointestinal bleed
stenosis or occlusion
trauma
abdominal angiography purpose
-demonstrates the contour and integrity of the abdominal vasculature
-placement or displacement of abdominal vessels being studied and possible obstruction or tears(eg aneurysm)
abdominal angiography catheterization
-for aortogram the aorta is accessed by femoral artery
-pigtail catheter is usually used due to large amount of contrast used
abdominal angiography
selective arteriogram
-require the use of specially shaped catheters to access the vessel of interest
what are common selective arteriogram studies
celiac artery
renal arteries
superior and inferior mesenteric arteries
all selected when a gastrointestinal bleed is investigated
Abdominal Angiography
super selective study
-involves study of selecting a branch of a vessel
-comon example is section of the hepatic or splenic artery
Abdominal Angiography
catheterization
-seldinger technique is used to access femoral artery or an alternative injection site for a peripheral arteriogram
-for lower limb arteriograms the side of acres depends on if it is unilateral or bilateral
-unilateral studies usually require access from contralateral side of interest
-for bilateral either femoral artery may be accessed
peripheral angiography clinical indications
-atherosclerotic disease
-vessel occlusion and stenosis
-trauma
-neoplasm
-embolus and thrombus
what is the purpose of a peripheral angiography
-examine the peripheral vasculature after injection of contrast
-may be an arteriogram where the injection is done by catheter or venogram where the injection is placed into distal vein of extremity
peripheral angiography catheterization
-seldinger technique is used to access femoral artery or an alternative injection site for a peripheral arteriogram
-for lower limb arteriograms the side of acres depends on if it is unilateral or bilateral
-unilateral studies usually require access from contralateral side of interest
-for bilateral either femoral artery may be accessed
Peripheral Angiography Upper Limb Catheterization
-catheter is advanced along the abdominal and thoracic aorta
-the side being examined is the Side the subclavian artery is used
Peripheral Angiography imaging lower limb
more common due to peripheral arterial disease
Joint injections
image guided joint access is commonly used.
-can be used for therapeutic injections or diagnostic purposes(injections for MR and CT arthrogrpahy,anesthetic testing for pain relief)
angioplasty
-procedure in which a balloon tipped catheter is used to open narrowed or blocked blood vessel
-imaging guidance is used to place catheter across narrowing
embolization
-brain aneurysms and arteriovenous malformations/fistulas
-uses imaging guidance to place metal coils into and aneurysm to block flow of blood and prevent rupturing
-also used to fill AVMS-abnormal connection btw veins and arteries- with liquid embolic agents
-embolization treats aneurysms and AVMS previously thought to be inoperable
catheter Embolization
-places medications or synthetic materials called embolic agents through a catheter into a blood vessel to block blood flow to an area of the body
-may be used to control or prevent abnormal bleeding, close off vessels supplying blood to a tumour, eliminate abnormal connections btw arteries and veins, or treat aneurysms
catheter directed thrombolysis
-teats vascular blockages and improve blood flow by dissolving abnormal blood clots
-uses fluoroscopic imaging and a catheter to guide thrombolytic meds or medical device to the site of blood clot to dissolve the blockage
percutaneous Abscess Drainage
-abscess is a infected fluid collection
-uses image guidance to place a needle or catheter through the skin into the abscess to remove or drain the fluid
-faster recovery than open surgery
needle biopsy-
-uses imaging guidance to help locate a nodule or abnormality and remove a tissue sample for examination
-biopsy may be needed when imaging can not confirm if nodule is benign
-will need an expiration chest Xray after to rule out possible pneumothorax
abscess drainage- CT
valuable in gaining access to deeper or more posterior parts of the body
IVC filters
-inferior vena cava filter is a end-vascular device typically placed in the infrarenal IVC to prevent pulmonary embolism
-most commonly done by interventional radiologist with fluoroscopic guidance
IVC filter indications
-contraindication to anticoagulation, eg active gastrointestinal bleed or recent neurosurgery
-pulmonary embolism despite anticoagulation
-poor patient compliance with anticoagulation treatment
-large iliocaval or floating IVC thrombus “widow-maker” thrombus
TIPSS(Transjugular Intrahepatic Portosystemic Shunt)
-creates an artificial passageway for portable venous circulation
-used to connect two veins within the liver
-shunt is kept open by a stent
-using image guidance a tunnel through the liver to connect the portal vein to one of the hepatic veins
-stent is placed in the tunnel to keep the pathway open
ureteral stent
-double stent, JJ stent, retrograde ureteric stent
-urological catheters that have two J shaped(curled) ends, one end is anchored in the renal pelvis and the other inside the bladder
-stents are used for passage of urine from kidney to the bladder
-ureteric stents may be placed integrate or retrograde
-stnets may be used for short or long period of time depending on indication
indication for a ureteric stent
-obstruction form urolithiasis-stones in the ureter
-malignant obstruction
-benign strictures
-retroperitoneal fibrosis
vertebroplasty
-is an imaging-guided procedure which entails percutaneous injection of surgicalbone cement into a diseased vertebral body
-provides pain relief and strengthens the bone of vertebrae
vertebroplasty indications
-It can be used as a treatment or as a palliative measure for:
-insufficiency fracture
-aggressivehemangioma
-vertebralmultiple myeloma
-vertebral metastases
Arterial stenting
expandable tubular medical meshwork devices used for interventional treatment of coronary artery disease, peripheral artery disease and AAA
esophageal stent
-treatment option in patients with esophageal strictures
-most commonly used for symptomatic relief in those with dysphagia
-stent is inserted with endoscopic and fluoroscopic control
-distal esophagus is most common site
Tracheobronchial stent
-device used in the treatment of symptomatic airway compression
-inserted under bronchoscope guidance in patients with external compression from mediastinal based malignancy( lung cancer, esophageal cancer)
-bronchial stents can also treat post lung transplantation airway stenosis
