Introduction To Imaging

Front 1

Questions to ask prior to obtaining an x-ray

Back 1

– 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?

Front 2

Types of Diagnostic Radiography (“x-rays”)

Back 2

– Routine (“plain x-rays”)
– Enhanced / Contrast Studies
– Tomography
– Fluoroscopy
– Mammography
– Computerized axial tomography (“CAT or CT scan”)
– Special Procedures
• Angiography
• Interventional procedures
• Cardiac catheterization

Front 3

plain x-rays

Back 3

performed without contrast media or augmentation techniques.
used for routine examinations (such as skull, chest, abdomen, and bones).

Front 4

fluoroscopy

Back 4

x-rays pass through the body to a fluorescent viewing screen that is coated with calcium tungstate.

Front 5

tomography

Back 5

x-ray represents a section of tissue at different levels

Front 6

enhanced/contrast studies

Back 6

use contrast agent such as barium, iodine, or ionized oils.
can be administered orally, rectally, intravenously, percutaneously, inhalation, urinary catheterization

Front 7

mammography

Back 7

detects breast cancers, benign tumors, and cysts before palpable.

Front 8

CT scan

Back 8

computers recreate a 3D, cross-sectiona view of body structures after obtaining x-ray information from the entire cicumference of the body

Front 9

angiography

Back 9

view arterial vasculature

Front 10

cardiac catheterization

Back 10

used to visualize heart chambers, arteries, and great vessles; mosts often used to evaluate chest pain.

Front 11

Study provides ... “pictures”

Back 11

anatomical

Front 12

Radiographic densities

Back 12

– Gas
– Fat
– Fluid
– Bone
– Metal

Front 13

Complication related to ionizing radiation

Back 13

– Pregnancy
– Radiation sickness

Front 14

Complications related to contrast studies

Back 14

– Allergic reaction
– Renal failure

Front 15

Complications related to special procedures

Back 15

– Organ / vascular perforation
– Infection
– Embolic event

Front 16

Factors that may interfere with x-rays

Back 16

• Metallic objects
• Retained contrast material
• Overlying structures or bowel contents
• Position
• Movement

Front 17

Types of Diagnostic Medical Sonography (Ultrasound)

Back 17

– Abdomen
– Obstetrics and Gynecology
– Echocardiography
– Breast
– Neurosonography
– Vascular sonography
– Procedures
– Structure evaluation

Front 18

Diagnostic Medical Sonography
(Ultrasound)
– Energy source?
– Risk associated with procedure?
– Study provides?

Back 18

*high frequency sound waves
*none
*anatomical “pictures”
Physiology information

Front 19

Advantages of diagnostic medical
ultrasonography

Back 19

• Usually non-invasive
• Painless (usually)
• Portable
• Real time evaluation with dynamic images
• Inexpensive

Front 20

Potential adverse effects / complications of
diagnostic medical ultrasound

Back 20

related to procedural issues

Front 21

Principles of Ultrasonography

Back 21

• B-scan
• M-mode scan
• Real Time
• Doppler
• Color flow doppler
• Duplex scanning

Front 22

real time imaging

Back 22

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)

Front 23

doppler ultrasound

Back 23

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).

Front 24

color flow doppler

Back 24

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

Front 25

duplex scanning

Back 25

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

Front 26

B-scan

Back 26

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

Front 27

M-mode

Back 27

shows motion of heart over time (echocardiography)

Front 28

Contraindications to diagnostic medical ultrasound

Back 28

• Procedure related

Front 29

Factors that may interfere with diagnostic medical ultrasound

Back 29

• Air
• Obesity
• Patient Movement

Front 30

Magnetic Resonance Imaging (MRI)

Back 30

– Routine
– Magnetic Resonance Angiography (MRA)
– Spectroscopy
– Functional Magnetic Resonance Imaging
(fMRI)

Front 31

MRI uses

Back 31

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

Front 32

MRA uses

Back 32

provides detailed images of blood vessels without using any contrast material

Front 33

MRS uses

Back 33

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)

Front 34

MRI:
Energy source?
Risk associated with procedure?
Study provides?

Back 34

*Radiofrequency waves and
magnetic field
*Movement and/or heating of ferrous material
*Anatomical “pictures”
Physiologic data

Front 35

Potential Adverse Effects / Complications /
Contraindications or Interference of magnetic
resonance imaging.

Back 35

• Related to movement of implants
• Heating of metalic objects
• Patient status
• Obesity

Front 36

Reasons to request magnetic resonance imaging

Back 36

• Soft tissue
• Neural tissue
• Bones and joints

Front 37

Nuclear Medicine Imaging Studies

Back 37

– “Routine”
– SPECT (single photon emission computed
tomography)
-PET (positron emission tomography)
– Molecular imaging

Front 38

SPECT (single photon emission computed tomography)

Back 38

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

Front 39

PET (positron emission tomography)

Back 39

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)

Front 40

Nuclear Medicine Imaging
– Energy source?
– Risk associated with procedure?
– Study provides?

Back 40

*gamma radiation / positrons
*Ionizing radiation
Reaction to pharmaceuticals
*Physiology information

Front 41

Questions / Reasons to request nuclear medicine imaging

Back 41

• 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

Front 42

Contraindications to nuclear medicine imaging

Back 42

• Allergy
• Pregnancy
• Lactation

Front 43

Interfering factors of Nuclear Medicine Imaging

Back 43

• Medication
• Movement
• Uncooperative patient

Front 44

Fusion Imaging

Back 44

*Combines physiologic data with anatomic
pictures
• Computerized axial tomography (CAT / CT)
• Magnetic resonance imaging (MRI)

Front 45

Patient Evaluation

Back 45

*history
*PE
*diagnosic procedures
1) laboratory
2) imaging
3) other

Front 46

Sequencing of Imaging Studies

Back 46

*noncontrast (ultrasound, non-enhanced x-rays)
*contrast (periperhal, oral/rectal)

Front 47

Patient Preparation

Back 47

*pt. identification
*explanation
*medication (w/hold, prep)
*other considerations (NPO, urgency)
*privacy