w1 chest ultrasound and imagining Flashcards
What is the role of the radiologist in imaging modalities?
Vetting requests for imaging techniques - ensure imaging is needed and have chosen the correct image.
Provides a written report on the image to be discussed with the clinician
Perform interventional procedures that require imaging techniques e.g chest drain or biopsy
Present cases at MDT
What do junior doctors need to be able to do with clinical images?
Interpret x rays quickly and when radiologists are not available to identify emergencies
Understand the limitations of clinical images, hence know when something might be missed and another test needed.
What are the pros and cons of chest x-rays?
Quick
Cheap
Low dose of radiation
Portable
Losts of people can interpret them
Can exclude some emergencies.
What are the pros and cons of a chest CT?
Doughnut of truth
Cheap and quick
Patient must be able to come to CT
More radiation
May need contrast so canula required
Sees more detailed anatomy and physiology.
More complex to interpret
High dose radiation means no used often for young children or pregnancy women
Need specialist to help interpret.
What is the deal with contrast in clinical imaging?
Often given as IV by a canula
Lights up structure on image, highlight vessels, bleeds cancers etc
Generally very safe but need to be aware of patients with renal failure so contrast would not leave the body.
Why is an ultrasound often not used for imaging the chest?
Sound shadow of ribs blocks lungs
Can’t see air filled structures, lungs, trachea etc
What is the deal with a PET scan for chest imaging?
Identify lung cancers by lighting up metabolic radiation (often radioactive glucose)
Very specialist
More expensive.
Longer wait time for test to be completed.
What is the general order that chest imaging techniques are taken?
Chest X-ray
Then followed by a chest CT.
What is a good way to remember to check everything in a chest x-ray interpretation?
A - airway and air
B - bones and breathing (lung borders and appearance, including hilum)
C - cardiac and corners
D - diaphragm
E - everything else - hints based on patient history.
What might a pneumothorax look like on a chest x-ray?
Space where lung should be is too dark - sign of air
Increased opacity somewhere within the lung space is the edge of the collapsed lung
What does pneumonia look like on a chest x -ray?
Patchy and more opaque is the lung, as if potato painted.
What does the build up of fluid in the pleural cavity look like on a chest x-ray?
Fluid appears white, often at the bottom of the pleura cavity.
Meniscus like look at the top of the white patch
Appears the same for blood, pus or lymph.
What is the ABCDE for identifying heart failure on a chest x -ray?
A- alveolar odema, grey cloudy area found laterally to the heart is larger and looks like bat wings taking up the majority of the lungs
B- Kerly B lines
C- Cardiomegaly - heart is larger in diameter than 50% of the widest part of thoracic cage
D- Diversion of the vessels to the upper lungs, upper vessels are more prominent on x-ray, lower vessels are less prominent
E- Effusions, lost of clear step corners for the diaphragm.
What does COVID-19 look like on a chest x-ray?
Cloudy and more opaque along the peripheral edges.,
Lose the sharpness of the lung borders
What does pneumoperitoneum look like in a chest x-ray?
Build up of air so black under the diaphragm.
May push the diaphragm up to higher than it should be.
