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47 Cards in this Set

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Questions to ask prior to obtaining an x-ray
– What am I looking for?
– What is the best way to get what I’m looking for?
– How will the information be used?
• Diagnosis
• Treatment planning
• Evaluation / follow-up of therapy
• Monitoring
– What are cost considerations?
– What are the risks?
Types of Diagnostic Radiography (“x-rays”)
– Routine (“plain x-rays”)
– Enhanced / Contrast Studies
– Tomography
– Fluoroscopy
– Mammography
– Computerized axial tomography (“CAT or CT scan”)
– Special Procedures
• Angiography
• Interventional procedures
• Cardiac catheterization
plain x-rays
performed without contrast media or augmentation techniques.
used for routine examinations (such as skull, chest, abdomen, and bones).
fluoroscopy
x-rays pass through the body to a fluorescent viewing screen that is coated with calcium tungstate.
tomography
x-ray represents a section of tissue at different levels
enhanced/contrast studies
use contrast agent such as barium, iodine, or ionized oils.
can be administered orally, rectally, intravenously, percutaneously, inhalation, urinary catheterization
mammography
detects breast cancers, benign tumors, and cysts before palpable.
CT scan
computers recreate a 3D, cross-sectiona view of body structures after obtaining x-ray information from the entire cicumference of the body
angiography
view arterial vasculature
cardiac catheterization
used to visualize heart chambers, arteries, and great vessles; mosts often used to evaluate chest pain.
Study provides ... “pictures”
anatomical
Radiographic densities
– Gas
– Fat
– Fluid
– Bone
– Metal
Complication related to ionizing radiation
– Pregnancy
– Radiation sickness
Complications related to contrast studies
– Allergic reaction
– Renal failure
Complications related to special procedures
– Organ / vascular perforation
– Infection
– Embolic event
Factors that may interfere with x-rays
• Metallic objects
• Retained contrast material
• Overlying structures or bowel contents
• Position
• Movement
Types of Diagnostic Medical Sonography (Ultrasound)
– Abdomen
– Obstetrics and Gynecology
– Echocardiography
– Breast
– Neurosonography
– Vascular sonography
– Procedures
– Structure evaluation
Diagnostic Medical Sonography
(Ultrasound)
– Energy source?
– Risk associated with procedure?
– Study provides?
*high frequency sound waves
*none
*anatomical “pictures”
Physiology information
Advantages of diagnostic medical
ultrasonography
• Usually non-invasive
• Painless (usually)
• Portable
• Real time evaluation with dynamic images
• Inexpensive
Potential adverse effects / complications of
diagnostic medical ultrasound
related to procedural issues
Principles of Ultrasonography
• B-scan
• M-mode scan
• Real Time
• Doppler
• Color flow doppler
• Duplex scanning
real time imaging
multiple transducers are used to display a rapid sequence of images (like a movie) instantaneouly while an object is being examined (fetal movement of motion of heart)
doppler ultrasound
sound waves are transformed into audible sounds or linear graphic recordings
*in blood vessels, the RBCs within the vessel distort the frequency of the ultrasound wave. the change in frequency is proportional to the velocity of the RBC. greater blood flow, the greater the frequency distortion (or Doppler shift).
color flow doppler
used to determine direction (recorded as colors) and velocity (shades) of blood flow in the chambers of the heart.
evaluate heart valve regurgitation and blood shunting in patients with heart defects
duplex scanning
real time imaging and color flow doppler imaging combine to demonstrate how the arteries and veins are functioning and velocity and turbulence within the vessels.
useful to detect plaque within arteries, demonstrate aneurysms, and assess renal or liver transplants for rejecton
B-scan
image is made up of series of dots, each indicating a single ultrasonic echo. position of dot corresponds to the time elapsed, and the brightness of the dot corresponds to the strength of the echo. movement of the transducer over the skin yields a 2D cross-sectional image
M-mode
shows motion of heart over time (echocardiography)
Contraindications to diagnostic medical ultrasound
• Procedure related
Factors that may interfere with diagnostic medical ultrasound
• Air
• Obesity
• Patient Movement
Magnetic Resonance Imaging (MRI)
– Routine
– Magnetic Resonance Angiography (MRA)
– Spectroscopy
– Functional Magnetic Resonance Imaging
(fMRI)
MRI uses
most important is to evaluate headache or neurologic signs on CNS lesions, neck and back pain for disc herniation, and bones and joints (especially knee) after traumatic injury on chronic pain
MRA uses
provides detailed images of blood vessels without using any contrast material
MRS uses
noninvasive procedure that generates high-resolution clinical images based on the distribution on chemicals in the body (ie. investigate myocardial metabolism without exposing the patient to ionizing radiation)
MRI:
Energy source?
Risk associated with procedure?
Study provides?
*Radiofrequency waves and
magnetic field
*Movement and/or heating of ferrous material
*Anatomical “pictures”
Physiologic data
Potential Adverse Effects / Complications /
Contraindications or Interference of magnetic
resonance imaging.
• Related to movement of implants
• Heating of metalic objects
• Patient status
• Obesity
Reasons to request magnetic resonance imaging
• Soft tissue
• Neural tissue
• Bones and joints
Nuclear Medicine Imaging Studies
– “Routine”
– SPECT (single photon emission computed
tomography)
-PET (positron emission tomography)
– Molecular imaging
SPECT (single photon emission computed tomography)
a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera. However, it is able to provide true 3D information. This information is typically presented as cross-sectional slices through the patient
PET (positron emission tomography)
radioactive chemicals administered that show the metabolic process of the cells of a particular organ being imaged: shows structure and metabolism (unlike MRI and CT)
Nuclear Medicine Imaging
– Energy source?
– Risk associated with procedure?
– Study provides?
*gamma radiation / positrons
*Ionizing radiation
Reaction to pharmaceuticals
*Physiology information
Questions / Reasons to request nuclear medicine imaging
• To evaluate for metastasis.
• To evaluate the patency (plumbing) of a structure.
• To evaluate organ function / status
•To localize pathology
• To aid in diagnosis
• Treatment
Contraindications to nuclear medicine imaging
• Allergy
• Pregnancy
• Lactation
Interfering factors of Nuclear Medicine Imaging
• Medication
• Movement
• Uncooperative patient
Fusion Imaging
*Combines physiologic data with anatomic
pictures
• Computerized axial tomography (CAT / CT)
• Magnetic resonance imaging (MRI)
Patient Evaluation
*history
*PE
*diagnosic procedures
1) laboratory
2) imaging
3) other
Sequencing of Imaging Studies
*noncontrast (ultrasound, non-enhanced x-rays)
*contrast (periperhal, oral/rectal)
Patient Preparation
*pt. identification
*explanation
*medication (w/hold, prep)
*other considerations (NPO, urgency)
*privacy