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20 Cards in this Set
- Front
- Back
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Breast US indications
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First line for patient < 30yo with palpable abnormality, breast feeding or pregnant
Further evaluation of mammographic findings Identification of palpable and non-palpable clinical sx Breast implant problem solving Nipple discharge problem solving US-guided bx 2nd look US following MRI Less likely: - Radiation tx planning - monitoring tx response - whole breast US screening - metastatic dz, unknown primary, negative mammo |
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Indications for Breast MRI
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Evaluate extent of disease in known CA
Metastatic LN with unknown primary Screening for contralateral breast in newly diagnosed CA Response to therapy Screening in pt with >20-25% lifetime risk: - BRCA1/2 - Untested primary relative of known BRCA1/2 carrier - Strong family hx - previous radiation tx <30yo |
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BIRADS descriptors for MASS (4)
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Round
Lobular Oval Irregular (suspicious) |
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BIRADS descriptors for MARGINS (5)
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Circumscribed
Microlobulated Obscured Indisctinct/Ill-defined (suspicious) Spiculated (suspicious) |
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BIRADS descriptors for DENSITY (4)
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Density compared to an equaly volume of breast tissue
High Isodense Low (but w/o fat) Fat-containing radiolucent |
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BIRADS descriptors for Typically-Benign CALCIFICATIONS (9)
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Skin
Vascular Coarse/Popcorn-like Large rod-like Round (> 1 mm) Punctate (<0.5 mm) Lucent-centered Eggshell/Rim Milk of calcium Suture Dystrophic - post traumatic or XRT |
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BIRADS descriptors for Intermediate concern, suspicious CALCIFICATIONS (2)
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Amorphous/Indistinct
Coarse Heterogeneous - may represent elvolving dystrophic |
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BIRADS descriptors for higher probability of malignancy CALCIFICATIONS (2)
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Fine pleomorphic
Fine linear/Fine linear branching |
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BIRADS descriptors for calcifications, DISTRIBUTION MODIFIERS (5)
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Diffuse/scattered
Regional (> 2 cc, > 1 segment) Grouped/clustered (> 5 calcs) Linear (suspicious) Segmental (suspicious) |
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BIRADS descriptors for SPECIAL CASES (4)
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Assymetric tubular structure
- dilated duct Intramammary LN Global assymetry - may be concerning if palpable Focal asymmetry - seen in 2 views but lacking characteristics of mass |
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BIRADS descriptors for ASSOCIATED FINDINGS (6)
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Skin retraction
Nipple retraction Skin thickening Trabecular thickening Skin lesion Axillary adenopathy |
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Adrenal mass formulas
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Absolute washout (> 60% = adenoma)
(Enhanced - Delayed) / (Enhanced - Unenhanced) Relative washout (> 40% = adenoma) (Enhanced - Delayed) / Enhanced |
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Radiation Dose Limits
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1 rem = 0.01 Sv or 100 rem = 1 Sv
Rad Worker: Whole body 5 rem Lens 15 rem Organ / Extremity 50 rem Fetus 0.5 rem Joe Blow 0.1 rem |
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Carotid stenosis by US
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ICA PSV
< 125 cm/s = normal < 125 cm/s = < 50% stenosis 125-230 cm/s = 50-69% stenosis > 230 cm/s = >70% stenosis ICA/CCA PSV < 2 = normal or <50% stenosis 2-4 = 50-69% stenosis > 4 = >70% stenosis ICA EDV <40 cm/s = normal or <50% stenosis 40-100 cm/s = 50-69% stenosis > 100 cm/s = >70% stenosis |
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Nukes medical events
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Exceeding dose limits
Dose is +/- 20% Wrong patient Wrong route Wrong radionuclide Leaking source Dose resulting in permanent organ damage THEN: Call NRC within 24 hours Notify referring physician Notify NRC writing in 15 days Notify radiation safety officer |
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Nuke med packages
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White (1) < 0.5 mrem/hr surface, 0.05 @ 1 m
Yellow (2) < 50 mrem/hr surface, 1 @ 1 m Yellow (3) < 200 mrem/hr surface, 10 @ 1 m Wipe test 300 cm2, < 200 dpm/cm2 Monitor within 3 hours |
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Major spill, minor spill
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Major spill =
> 100 mCi (Tc99, Ga67, Ti201, Co57) > 10 mCi (P32, In111, I123, Au198) > 1 mCi (I131, I 125) Major spill Clear area Notify personnel Prevent spread Shield Notify HPO Decontaminate Spill Report Minor Spill Clear area Notify personnel Prevent spread Clean Up Survey Notify HPO |
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Well counter QC
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CLAG
Daily, Quarterly, Annually, Installation |
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Camera QC
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Uniformity
- daily flood Resolution - weekly bar phantom Linearity - weekly bar phantom |
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Breast QC
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Daily
Darkroom cleanliness Processor quality control Weekly Screen Cleanliness Viewboxes & viewing conditions Phantom images Monthly Visual checklist- assure x-ray equipment is optimal Quarterly Repeat analysis- determine number & cause of repeat mammos Analysis of fixer retention in film Semiannually Darkroom fog Screen-film contact Compression |
