Intro to Radiology Final Study Guide Week 1 (1) Know when and who invented Radiology. Wilhelm Conrad Roentgen discovered x-rays in 1895. (2) Understand the concept of projection and how it affects image quality. The quality of a medical image is determined by the imaging method, the characteristics of the ‘equipment and the imaging variables selected by the operator. Image quality is not a single factor but is a composite of at least 5 factors: contrast, blur, noise, artifacts and distortion. “™ Less magnification occurs if the heart is closer to the plate. * PA CXR if pt is standing facing the plate bic radiation enters body from back(P) to front(A) (8) Understand the concept of how an image is formed. A) In projection imaging (radiography and fluoroscopy), images are formed by projecting an x-ray beam through the patient's body and casting shadows onto an appropriate receptor that converts the invisible x-ray image into a visitle light image. - The gamma camera records a projection image that represents the distribution of radioactive material in the pt's body. - The primary advantage of this type of image is that a large volume of the patient's body can be viewed with one image. - Adisadvantage is that structures and objecis are often superimposed so that the image of one might interfere with the visibility of another. - Projection imaging produces spatial distortion but its not usually a major problem. B) Tomographic imaging, i¢., conventional tomography, computed tomography (CT), sonography, single photon emission tomogrephy (SPECT), positron emission tomography (PET), and MRI, produces images of selected planes or slices of tissue in the patient's body. ~ The advantage of tomographic imaging is better visibility of objects within the imaged plane. One factor that contributes to this is absence of overlying objects. - The major disadvantage is that only a smal slice of a patient's body can be visualized with one image. Therefore, most tomographic procedures usually require many images to survey an entire organ system or body cavity. (4) Understand the amount of radiation exposure with different radiologic modalities. Safety is provided by distance, minimal time, and shielding. ‘Table: American College of Radiology appropriateness criteria, relative radiation level information Relative radiation | Effective dose estimate Example examinations level range ‘None Ultrasound, MRI Minimal mse Chest radiographs, hand radiographs,Shu'l vray Low 1-5 mSv Head CT, tu radiographs IV “AE Medium 5-10 mv ‘Abdomen CT, barium enema, nuclear medicine High >10msv ‘Abdomen CT without and with contrast, whole vody PETWeek ue abdomen Plain Films and Uttrasound/Mith IR): ee Itrasound is best at visualizing hollov filled organs, for gallstones, cholecystitis, ascites, uterus/ovarie: Plain film- Fast, easy, cheap, and readily available. Used in looking for small bowelarge bowel ob conatipation, oF free intraperitoneal air (elthough the best test for free intraperitoneal air is @ CT) | (plain film, cat scan, or ultrasound) CT > plain film > Ultrasound Understand the best test to order for: Gallbladder disease -Uitrasound, appendicitis -CT (ultresound is good in peds but ni kidney stones - non contrast CT. testicular pain Ultrasound, ovarian/gyn issues Ur ‘Be able to identify the following on a plain X-ray of the ebdomen: Sane eee teanied Sot ally located in the abdonen, plicae circularis ic density pan the diameter of the intestine; dileted small bowel loops; air fluid len 30 good in adi nd ansve n laterally es that do not span the diameter of the co lated loops of© Constipation corre! presenting symptoms, and exam. on x-ray, may have di n is opaque white surrounded by owel gas. acer Multiple fecal lumps backed up in colon. Fecal impaction in rectum. (above x ray) Constipation in a young child as seen by X-ray. Circles represent areas (stool is opaque white surrounded by black bowel gas). 0 Free Intraperitoneal Air usually caused by intestinal perfor under the diaphragm. (differentiate from gastric bubble whichSiK Wook Fa%% (Abdomen: CT & Sectional Anatomy Part One) lausea, Vomiting, Fever, tWBC, Unknown weight loss, Hematuria, Renal stones, S80, Abscess, Cancer, AAVaortic dissection, Trauma Abdominal pain, Distended abdomen, Appendicitis, Diverticultis, Pancreatitis CT arenchymal enhancement, Helps distinguish fluid from solid, Evaluate vasculature, Phase of contrast arterial, venous, delayed, Why pa.contrast? May obscure important findings (renal stones), Renal insufficiency, lodine allergy, Heal pau sei ne a oK Decreased enhancement of kidney, hydronephrosis, Dilated ureter. Look for Stone (white) ‘Appendicitis: Look for enlarged appendix in RLQ, Localized thickening and hyperemia invalving a segment of the colon wall, with inflam. changes extending into fatty tissues surrounding the colon. Confident dx when involved segment contains diverticulae. inal Aortic An ‘Abdominal aortic aneurysm (AAA) Risk of rupture > 5-8cm,Ddx: aortic dis 1, e white circle just anterior to the vertebral column Corns : hid pee pbloclrge ete) Gh (Welt slulde wcBaswn\ CED paid poh, La tans = Ty (iodkveoased; for asolsie VS. Vee, Oye VS gel wf OT Wr Oy pple ds, pregnant women ee SA es)More Week 2: Urolithiasis on Plain Film Not Always Visualized! om OSL (lem oy me) (1a \V181e] . Peat) 2 — Insufficient calcium in ) stone (e.g. uric acid me stone) Semeur) ¥ — Hard to differentiate a from other calcifications : More Week 6:opens: ne wer fas el yet rurtur sonded end silanes, Inthis patent the append ror inemation S60 CT Diverticulitis: cera en) Cees hid Se) Pe rmer tte Dera CT co Os pi em into ie ft surandng be sgn co ae aon) who wa ficken nearer) CTAAA No evidence of AAA ruptureWeek ee (Chest: Part One) Understand X-tay densities and transmission of Xrays Radiolucent => radiodense air, fat, soft tissue, calcium, contrast, bone, metal (sometimes abbreviated to air, fat, soft tissue, bone) due to differential absorption of x-rays How is an X-ray rendered visible on a radiograph items become visible due to juxt sition of two differert densities _ air filled bronchus surrounded by airless lung Be able to identify the following on a chest xray: © Normal Chest X-ray ‘9 Pneumonia ‘© Congestive Heart Failure oni oujed y)(3) Describe the term that indicates when di‘ferent densities may appear the same on a iedieg ell as being familiar with the maj ssctneciientin 2 roduced when two fluid densities are contiguous and the individual outline ‘each is lost. Commonly used in the evaluation of chest problems. ‘Loss of different densities when a film is too dark is due to OVER exposure, while a film that is too white would be considered UNDER exposed could also explain different densities appearing the same. The silhouette sign refers to loss of normal border between structures, or an intra-thoracic radio opacity obscuring the border of the heart or aorta due to a contiguous structure. In other words it is difficult to make out the borders of a particular structure - normal or otherwise - because it is next to another dense structure, both of which will come up as white on a standard X-ray. It may occur, for example, in middle lobe disease, where the right heart margin is lost, and in right lower lobe pneumonia, where the border of the diaphragm on the right side is obscured, while the right heart margin remains distinct. In many situations an artifact does not significantly affect object visibility and diagnostic accuracy. But artifacts can obscure a part of an image or may be interpreted as an anatomical feature. A variety of factors associated with each imaging method an cause image artifacts. ee Check the image for Inclusion: A chest X-ray should include the entire thoracic cage. Look for First ribs, costophrenic angles and the lateral edges of ribs. Projection: PA projection is typical. X-rays pass from the posterior to the anterior of the patient - hence Posterior-Anterior (PA) projection. The image is viewed as if looking at the patient face-to-face. Rotation: The spinous processes of the thoracic vertebrae are in the midline at the back of the chest. They should form a vertical line that lies equidistant from the medial ends of the clavicles, which are at the front of the chest. Rotation of the patient will lead to off setting of the spinous processes so they lie nearer one clavicle than the other. Find the medial ends of the clavicles, Find the vertebral spinous processes, The spinous processes should lic half way between the medial ends of the clavicles Assessing inspiration Inspiration: To assess the degree of inspiration it is conventional to count ribs down to the diaphragm, The diaphragm should te intersected by the Sth to 7th anterior ribs in the mid-clavicular line. Less is a sign of incomplete inspiration, Penetration: A well penetrated chest X-ray is one where the vertebrae are just visible behind the heart, Although X-rays are sill occasionally over or under exposed, a discussion of penetration now best serves as a reminder to check behind the heart. The left hemidiaphragm should be visible to the edge of the spine. Loss of the hemidiaphragm contour or of the paravertebral tissue lines may be due to lung or mediastinal pathology. -xamples include rotation, inzomplete inspiration and incorrect penetration. Other radiographic artifact includes clothing or jewelry not removed. Other common artifact to find is medical or surgical equiptment like NG tubes.CIV Te Mme OTaT Eyes (elcid (ig ices o)-3 0 1yUO1g ago} Jaddn ya} 9 1UBIY « ET ]ol-s¥ oli @iey WAT AS: (.) seyuape Areuownd jequeg - LOS oN Coy =) See pic or lost, (click here for link) OF wext % a. Good Walk-through of traumatic Head injury/skul fracture 2) What is the most common cause of: blunt trauma, shaken baby, alcoholics, elderly with whiplesh -Subarachnoid- marfans, ehlers-danlos, APCKD, hypertension, -Intracerebral- hypertension, amyloid angiopathy, Epidural Bleeds- trauma 3) 1 cau i Hypertension 4) Be able ; lenticular, homogenous color, well defined, middie meningeal A ‘Subdural Bleed- crescentic, crosses suturesLinear Skul Fracture F-= frontal hom of lateral ventricle 3 third ventricie © -occipital hom of lateral ventricle ‘Skul Fracture