Rad 1

Front 1

Radiographic density

Back 1

- air< fat<water<bone<metal

-gradation from black to white suggests density

Front 2

What type of energy is an x-ray and how is it measured?

Back 2

Electromagnetic radiation measured in electron volts

Front 3

What determines the amount of x-rays absorbed by a particular material?

Back 3

Atomic weight and/or density

Front 4

Exposed x-ray film appears what color? What color are shadows?

Back 4

Black, white

Front 5

What are the 5 factors that affect x-ray images?

Back 5

Thickness
Motion
Scatter
Magnification
Distortion

Front 6

Which 2 factors are related to patient positioning?

Back 6

Magnification
Distortion

Front 7

What is the most common type of x-ray procedure? Give examples.

Back 7

Plain films – CXR, KUB, bone film

Front 8

What are the indications for fluoroscopy?

Back 8

cardiac movement
GI movement
placement of feeding tubes

Front 9

What are 2 types of tomography?

Back 9

computed tomography and positron emission tomography

Front 10

What are the indications for a CT scan?

Back 10

Injuries
evaluation of internal organs
suspected tumors
bleeding
pulmonary embolism

Front 11

In what areas of the body are contrast studies utilized?

Back 11

GI tract,
urinary tract
blood vessels

Front 12

What radiology procedures can contrast be used in?

Back 12

Plain films
CT
MRI

Front 13

If you wanted to look for abnormalities in the esophagus, stomach and duodenum, what study would you order?

Back 13

UGI

Front 14

What are the indications for a nuclear medicine study?

Back 14

Evaluate physiology of organs such as bone, heart, lungs, thyroid and kidneys. Also used to look for occult bleeding.

Front 15

What are the advantages of a MRI scan? Disadvantages?

Back 15

- No radiation, excellent view of soft tissues and central nervous system, non-invasive
– too expensive, cannot have any metal near the MRI.

Front 16

What are the indications for an ultrasound study?

Back 16

View organs and evaluate motion - particularly cardiology, ob/gyn, GI, and vascular medicine.

Front 17

How is an MRI developed

Back 17

Molecules in the body give off energy after being exposed to a magnetic field and radiofrequency beam – the energy is measured and the computer generated a picture of the structure

Front 18

a way of occluding (closing) one or more blood vessels. This approach can be used to control or prevent abnormal bleeding as well as shut down the vessels that support a growing tumor.

Back 18

embolization

Front 19

What are the 8 steps in reading a CXR?

Back 19

1-determine age, sex, hx
2-type & quality of film
3-position of patient
4-inspiratory effort
5-structures
6-blind spots
7-old films
8-ddx

Front 20

How do the structures on a portable CXR differ from a PA view?

Back 20

heart appears larger, less inspiratory effort

Front 21

What is the indication for a lateral decubitus view?

Back 21

Pleaural effusion

Front 22

How large is the heart on a normal PA film?

Back 22

less than ½ of the width of the entire chest, about 1/3 of the width of the chest

Front 23

What structures are present in the mediastinum?

Back 23

heart
major blood vessels
lymph nodes
thymus
thyroid

Front 24

What is the normal positions of the hila and describe the pulmonary vasculature?

Back 24

Left hilum should be higher than right hilum and vasculature should be more distinct in the lower lobes and centrally.

Front 25

What is the normal position of the hemidiaphragms?

Back 25

right should be higher than left

Front 26

What are the proper positions of an ET tube and NG tube?

Back 26

- T tube should be 1 cm above the carina.
- NG tube should be seen curving left into the stomach.

Front 27

What are the “blind spots”?

Back 27

behind the heart
costophrenic angles
lung apices
bony lesions
small pneumothorax

Front 28

Why should you review old films?

Back 28

to look for subtle changes that may otherwise be missed.

Front 29

What is a silhouette sign?

Back 29

When you can’t see the cardiac border etc

Front 30

What does an air bronchogram signify?

Back 30

Consolitation in the Alveolar

Front 31

what type of Lesions are in the Anterior Mediastin

Back 31

Thymoma
thyroid lesions
teratoma
T-cell lymphomas
& lymphadenopathy

Front 32

Lymphomas are most commonly found where

Back 32

anterior mediastin

Front 33

90% of posterior lesions are

Back 33

neurogenic lesions

Front 34

Can an alveolar consolidation be present without seeing air bronchograms?

Back 34

Yes

Front 35

What is meant by an interstitial infiltrate? How does this appear on CXR?

Back 35

It is outside of the alveolar as little white markings

Front 36

Alveolar infiltrate can be?

Back 36

consolidation of pus, blood, fluids or proteins in alveoli which appears as a white defect on the CXR.

Front 37

Interstitial infiltrate?

Back 37

collection of fluid or cells in the interstitum

Front 38

How is community acquired pneumonia diagnosed? Why get a CXR?

Back 38

- Fever, cough, dyspnea, rales, pleuritic chest pain
- Helps r/o other causes or complicated disease

Front 39

What type of pneumonia is an immunocompromised patient susceptible to? How does it appear on CXR?

Back 39

Pneumocystis carinii pneumonia (PCP); Nrml CXR to interstitial pattern to alveolar pattern

Front 40

How does aspiration pneumonia differ from community acquired pneumonia CAP?

Back 40

Shows as an alveolar infiltrate whereas CAP can simulate a mass lesion such as a neoplasm

Front 41

What is the screening test for TB?

Back 41

Skin Testing

Front 42

How does the appearance of primary TB differ from reactivated TB?

Back 42

- Primary TB presents as focal mid or lower lobe consolidation w/ enlargement of hilar or mediastinal lymph nodes 95% of time
- Reactivated TB are usually in the posterior segments of upper lobes and superior segments of lower lobes

Front 43

How does the Ghon complex appear on CXR, and what does it indicate?

Back 43

Calcified hilar nodes or nodules; Represents; TB which is now healed – no active disease, also called Ranke Complex

Front 44

How can a lung abscess appear on CXR and what ddx do you have to rule out?

Back 44

May appear solid or cavitary with an air fluid level and a thick wall; must rule out neoplasm by bronchoscopy or CT-directed needle biopsy

Front 45

What is ARDS and how does it appear on CXR?

Back 45

Leaky capillaries causing flid shifts into the lungs from the blood supply through the capillaries.

Front 46

How does ARDS appear on CXR?

Back 46

Diffuse alveolar infiltrates with NO Kerley B lines, pleural effusions or cardiomegaly

Front 47

What are the 3 steps in evaluating a solitary pulmonary nodule?

Back 47

Location, characteristics, age of lesion by comparison to old cxr or presence of calcifications.

Front 48

What are the signs that a nodule may be malignant?

Back 48

larger than 3 cm, irregular borders, cavitating, not calcified, changed from previous films – growth over the past 2 yrs.

Front 49

When should you obtain a CT scan of a nodule?

Back 49

Almost always

Front 50

How is a definitive diagnosis of lung cancer usually made?

Back 50

bronchoscopy or lung biopsy

Front 51

What are the indications for a CT scan when evaluating a lung mass?

Back 51

New or enlarging lesion, larger than 3 cm in patient older than 35, any size in patient less than 35, no calcifications, hilar enlargement.

Front 52

What type of symptoms can occur with a pancoast tumor?

Back 52

Arm, shoulder pain and T-1 distribution symptoms

Front 53

Do other types of cancer metastasize to the lungs? How does this appear on CXR?

Back 53

Yes, the lesions may be large or small but have a more diffuse pattern than a primary lung CA.

Front 54

What organs does lung CA metastasize to? How do you evaluate these organs for metastases?

Back 54

Adrenal glands, liver, bones & brain – CT is needed for evaluation.

Front 55

What is bronchiectasis? How is it seen on CXR? What is the best study to evaluate for this? What is a late sign for this?

Back 55

Scarring and dilation of the bronchi or bronchioles due to recurrent or severe infections damaging the cartilage. CT is best study. A late sign is “tram-tracking.”

Front 56

What are the signs of COPD on CXR? When is a CXR indicated in COPD?

Back 56

Flattened diaphragms, blebs or bullae, blunting of costophrenic angles, increased AP diameter of chest on lateral view. COPD exacerbation, weight loss or suspicion of pneumonia, compression of the heart, mediastinum.

Front 57

What is a bleb? How is it different from a bullae? What does it represent as far as lung physiology?

Back 57

An air filled sac. A bullae is larger. Both represent loss of lung function.

Front 58

What is atelectasis?

Back 58

Collapse of part or entire lung – loss of functioning.

Front 59

How does atelectasis appear on CXR?

Back 59

Air is resorbed from the lung tissue therefore the tissue appears white on CXR. No air bronchograms seen. May appear linear or discoid if only a very small portion of lung tissue is involved.

Front 60

When does atelectasis occur?

Back 60

Caused by obstructing bronchial lesion, compression, fibrosis or loss of surface tension. Also occurs with poor patient inspiratory effort due to postop pain or trauma pain (broken ribs, etc).

Front 61

Describe the positioning of the patient, the film cartridge, and the x-ray cathode in routine CXR.

Back 61

72”

Front 62

In lateral CXR.

Back 62

L side always against the film!!!

Front 63

In portable CXR.

Back 63

Film against pt back, machine above @ 42”

Front 64

What difference does it make?

Back 64

AP has larger cardiac shadow

Front 65

When x-radiation is absorbed by a structure, what does the film look like?

Back 65

Shadows are white

Front 66

What is the sequence of absorption from the most absorption to the least?

Back 66

Bone, water, fat, air

Front 67

Describe the normal appearance of pulmonary vasculature and the hilar regions.

Back 67

Pulmonary vasculature should be seen to about 2/3 out towards the periphery – more pronounced in the lower lung fields than the upper lung fields. Left hilum is higher than right hilum (or equal) but the right should not be higher than the left.

Front 68

What is a consolidation? What is an air bronchogram?

Back 68

Collection of fluid or air (alveolar). Can see bronchiols (alveolar infiltrate).

Front 69

What are interstitial markings?

Back 69

Widening of the interstitial space

Front 70

How does interstitial pneumonia appear different than other interstitial markings such as Kerley B lines?

Back 70

Same process, b’s are ususally at base and lower corners

Front 71

What is atelectasis?

Back 71

Block of a bronchial tube causing deflation of affected portion, appears white on x-ray

Front 72

What causes pleural calcifications?

Back 72

old empyema or asbestosis

Front 73

What is in the Anterior mediastinum?

Back 73

ascending aorta
aortic knob
heart
lymph nodes
thyroid
thymus

Front 74

What is in the Middle mediastinum?

Back 74

esophagus
trachea
lymph nodes
aortic arch

Front 75

What is in the Posterior mediastinum?

Back 75

descending aorta
lymph nodes
spinal nerves
vertebral bodies

Front 76

When is a CT or MRI indicated?

Back 76

Always indicated for further evaluation

Front 77

What is most common cause of anterior mediastinal mass? Middle? Posterior?

Back 77

Anterior: Lymphoma
Middle: Enlarged lymph nodes
Posterior: neurogenic lesions

Front 78

What are signs of CHF on CXR?

Back 78

pulmonary vasculature is more pronounced and equal in upper and lower fields, pleural effusion, cardiomegaly, interstitial infiltrates (Kerley lines), severe disease can result in alveolar infiltrates.

Front 79

When is a CXR indicated in HTN? Chest pain?

Back 79

Initial dx, new onset sx, Physical; CP: based on hx

Front 80

What is cardiomegaly? What causes it?

Back 80

Enlargement of the Heart

Pericardial effusion
Cardiomyopathy
Valvular disease
Congenital heart disease
Mass lesions

Front 81

How does a pericardial effusion appear on CXR?

Back 81

Waterbag pendulous appearance

Front 82

How many CC’s of fluid must be present to be seen on CXR?

Back 82

250cc’s, can do an Echo

Front 83

Heart silhouette is larger than half the width of the chest
Caused by

Back 83

Valvular disease
Cardiomyopathy
Congenital heart disease
Pericardial effuion
Mass lesions

Front 84

How do CXR findings progress in CHF?

Back 84

- Mild: cephalization (prominance of the pulm vasculature)
- Mod: interstitum marking kurly b’s
- Severe: fluid backs up into the alveoli (pulm edema)

Front 85

How do you evaluate cardiac function?

Back 85

Ejection Fraction study with echo or MUGA

Front 86

What is the most common cause of left atrial enlargement and how does it appear on CXR?

Back 86

Mitral Stenosis, extra ‘bump’ L atrium

Front 87

In what condition do you see a “ski mogul heart”? How does it appear?

Back 87

Nob norm, Pulmonary ,LAE, LV norm ass w/ rhumatic fever

Front 88

What is endocarditis and how is it evaluated?

Back 88

- Infection of the cardiac valves
- Echo

Front 89

What is a pulmonary embolism and how is it evaluated?

Back 89

Clot in the pulm vasc
VQ scan
helical CT

Front 90

How do you evaluate for coronary artery disease?

Back 90

Echo
thallium stress test
pulm angiogram

Front 91

Which test is bestfor coronary artery disease?

Back 91

Angiogram

Front 92

Which test is first line in for a stable coronary artery disease pt?

Back 92

Echo

Front 93

What is the difference between an aortic aneurysm and dissection?

Back 93

- dilation of aorta with or without dissection of aortic wall

- separation of layers of aortic walls

Front 94

How do you evaluate for aortic disease?

Back 94

CT with contrast!!!!

Front 95

What is the first line test for evaluation of the peripheral vascular system? What is “gold standard”?

Back 95

Duplex U/S, Angiogram is gold standard.

Front 96

What type of energy is an X-ray and how is it measured?

Back 96

Energy of extremely short wavelength from electromagnetic radiation

Front 97

What determines the amount of x-rays absorbed by a particular material

Back 97

Substance’s density and atomic weight

Front 98

What is the most common type of xray procedure? Give examples?

Back 98

Plain films; CXR and skeletal films

Front 99

Indications for floroscopy.

Back 99

Used for viewing motion of the heart

Front 100

What are 2 types of tomography?

Back 100

CT and PET

Front 101

Indications for a CT scan?

Back 101

Evaluation of injuries, masses, tumors

Front 102

In what areas of the body are contrast studies utilized?

Back 102

GI, GU, Vascular

Front 103

What radiology procedures can contrast be used in?

Back 103

Plain films to highlight adjacent structures of similar densities
May also be used with CT and MRI

Front 104

If you wanted to look for abnormalities in the esophagus, stomach and douodenum, what study would you order?

Back 104

Upper GI barrium

Front 105

What are the indications for a nuclear medicine study?

Back 105

Looking for physiology

Front 106

What are advantages of MRI scan?

Back 106

Detail, soft tissue, no radiation involved, non invasive. Disadvantages: time, expensive

Front 107

Indications for ultrasound?

Back 107

Pregnancy, blood flow, echocardiogram for the heart.

Front 108

How do structures of a portable look diferent from a PA view?

Back 108

Shadow of heart are larger and it is AP. Inspiratory effort isn’t as good. Not as good quality.

Front 109

Most alveolar infiltrates appear how

Back 109

fluffy or appear as complete consolidation

Front 110

If the R cardiac border is obscured

Back 110

then the infiltrate must be in the RML.

Front 111

If the R hemidiaphragm is obsured

Back 111

then the infiltrate must be in the RLL.

Front 112

Interstitial processes appear how

Back 112

are usually diffuse & are seen as thin white lines.

Front 113

“spine sign” - useful in identifying

Back 113

infiltrative processes affecting lower lobes

Front 114

Deep sulcus sign on a supine chest radiograph is an indication of

Back 114

pneumothorax

Front 115

What condition can cause a false deep sulcus sign

Back 115

COPD

Front 116

what is Mycoplasma pneumonia

Back 116

Pneumonias that are interstitial and symmetrically diffuse in both lungs are usually atypical pneumonias caused by Mycoplasma, viruses, or Pneumocystis

Front 117

The most likely cause of an interstitial pneumonia in a normal adult is

Back 117

a mycoplasmal infection

Front 118

Adenocarcinomas are _______ and usually found where

Back 118

most common
usually occur peripherally

Front 119

Squamous cell carcinomas usually occur

Back 119

centrally and tend to cavitate.

Front 120

Small cell carcinomas often present as

Back 120

as an indistinct hilar or perihilar mass.

Front 121

 Large cell carcinomas can occur

Back 121

peripherally or centrally and grow rapidly with early metastases – poor prognosis.

Front 122

 Metastatic disease is common in what organs

Back 122

liver, adrenal glands, bones and brain.

- CT evaluation should include the liver and adrenals.

Front 123

Pancoast Tumor arise in the

Back 123

- superior sulcus of the lung as an apical soft tissue mass.
- Frequently invade the chest wall and the brachial plexus

Front 124

Rib destruction common in what disease process

Back 124

Pancoast Tumors

Front 125

Symptoms a Pancoast Tumor may include

Back 125

shoulder, arm and hand pain or weakness – T1 distribution most commonly.