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Radiology > Advanced Chest Imaging, Abdominal Imaging, Specialty Abdominal Imaging > Flashcards

Advanced Chest Imaging, Abdominal Imaging, Specialty Abdominal Imaging Flashcards

1
Q

Pregnancy tests and radiology

A

Get in habit of asking your pts of child bearing age, order UPT if warranted
Warranted if LMP is >1 mo
10 day rule: if within 10 days of LMP, you know they’re not pregnant

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2
Q

Chest trauma plain films- when to get, components?

A

True chest trauma, not isolated rib injury
Always indicated AP only and usually portable
Fast, cheap, easy, yields good info
CT chest always indicated ASAP

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3
Q

What can be seen on plain films for chest trauma?

A 
Rib fxs
Sternum fxs
Clavicle/shoulder fxs
Subq emphysema
FBS (GSW)
Pneumothorax
Widened mediastinum
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4
Q

Indications for CT chest

A

Clinical suspicion vs vague CXR findings, neg CXR with sick pt
CXR findings that are worrisome, 1” wide mediastinum, cardiomegaly, mass
Trauma, 1” blunt chest trauma think seatbelt sign
Known/unknown aneurysm with worrisome presentation
Worrisome for PE
CAD
Pericardial effusion

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5
Q

When to get a CT chest without contrast for chest

A

Greater than or equal to 50 yo with isolated rib injury/pain
Indeterminate findings on CXR, pt allergic to IV contrast
Indeterminate findings on CXR, pt has abnl renal fxn
Except for suspected PE
CXR neg but pt is ill, suspect pneumonia and has allergy or renal impairment
Radiologist preference or recommendation

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6
Q

Labs you must get before radiologist will give IV contrast

A

BUN
Creatinine
GFR

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7
Q

When to get a CT chest with contrast for chest

A

Trauma
Assess aneurysm
Dissection
Radiologist preference

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8
Q

When to get a CT chest with and without contrast for chest

A

Abscess assessment includes empyema
Tumor assessment
If you don’t know what it is or what it might be

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9
Q

What size needle to use for CT angiography

A

20g or higher, can’t use EJ IV access

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10
Q

What will a cardiac pt need for a CT angiography?

A

May need a BB

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11
Q

When to use CTA for chest

A

PE
CAD
Trauma

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12
Q

Types of u/s

A

Echo including TEE
FAST
Pericardial effusion
u/s guided thoracentesis

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13
Q

Echo indications for chest

A 
Cardiomegaly
Abnl EKG, think a fib
IVDU/lupus (valve dz)
Untreated HTN (LVH)
Diabetic pts (LVH)
CHF/CKD (LVH)
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14
Q

When to use chest u/s

A

Only for fluid location
u/s does not penetrate/image air/bone effectively
Pleural effusion
Assisting with thoracentesis

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15
Q

When to use nuclear medicine for chest imaging?

A

V/Q lung scan

Bone scan

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16
Q

When to use MRI for chest imaging?

A

Radiologist recommends

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17
Q

When to use PET for chest imaging?

A

Radiologist/oncologist recommends

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18
Q

Why do a V/Q?

A

For r/o PE if pt not able to have IV contrast

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19
Q

Purpose of bone scan

A

For skeletal abnormalities
Fx age
Bony mets

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20
Q

Types of plain film abdominal imaging

A

Acute abdominal series (PA chest, flat and upright abdomen)
Flat and upright
KUB
Lateral decubitus
True lateral abdomen if looking for FB, but usually go straight to CT

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21
Q

Why a PA chest for an abdominal complaint?

A

Can see free air under the diaphragms on a PA chest
Pt may have pneumonia or other lung tissue causing referred pain to the abdomen
If true acute abdomen, pt going to surgery will need a pre-op CXR

22
Q

Indications for plain film abdominal studies

A 
Abd pain
Constipation
Suspect bowel obstruction
CT unavailable
Recent CT with ileus/constipation/kidney stones
FB
Pediatric indications
23
Q

Indications for abdominal CT

A 
Abd pain, anywhere, any kind, acute or chronic, post op pain
Sepsis with no obvious source
Primary CA dx, r/o mets
Certain abnl lab values
Unintentional weight loss
24
Q

When to use no contrast in abdominal CT

A 
Suspect kidney stone
Vague abd pain complaint
Suspect bowel obstruction
Hernias
FBs (IUD gone missing, etc.)
Allergy to IV contrast
Impaired renal function
Radiologist recommendation/preference
25
Q

When to use PO and IV contrast with an abdominal CT

A 
R/o appy in a very slim pt
Post bariatric surgery pain
Pediatric r/o appy
Vague abd pain, outpt
If you prefer and are certain pt has no kidney stone
Radiologist recommendation/preference
26
Q

When to use IV contrast only with an abdominal CT

A 
Suspect ischemia of abdominal vessels
AAA
R/o appy in a very slim pt
Pancreatitis
Diverticulitis
Trauma
R/o mets
If you prefer and are certain pt has no kidney stone
Radiologist recommendation and preference
27
Q

When to get an abdominal CT with and without IV contrast

A

Abscess, think Crohn’s pts, diverticulitis, PID, TOA
Tumor, primary vs mets
Trauma, think CTA, otherwise with IV contrast only

28
Q

What does a CT abdomen cover?

CT pelvis?

A

Ct abdomen will scan from lung bases to iliac crests
CT pelvis scans from just above iliac crests to proximal hips
For completeness sake order both to include all the bowel and pelvic organs

29
Q

When should one get a CT pelvis only?

A

Perianal/perirectal abscess
Abscess to buttocks or perineum
Known FB to either rectum or vagina
F/u scan for specific tumor located solely in the pelvis

30
Q

What to get CTA of abd/pelvis

A

Aortic dissection
Abd vascular dz
RAS
PVD in legs will do aorta with femoral run off

31
Q

Reasons to get an u/s of the abdomen

A 
Fast, cheap, easy
Portable
No radiation
Excellent for cystic vs solid
However, has more limitations than CT scanning
32
Q

What is u/s jelly used for?

A

To fill the air gap between transducer and skin

33
Q

The higher the frequency of the transducer, the ______ ______ the penetration of tissues

A

More superficial

34
Q

What is gain in an u/s?

A

The strength of the sounds waves and will correct for fluid vs solid

35
Q

How should the best u/s images be obtained?

A

Use depth and gain

36
Q

Linear u/s transducer frequency

A

12 MHz

37
Q

Curved u/s transducer frequency

A

4 MHz

38
Q

Phased u/s transducer frequency

A

7 MHz

39
Q

What is a phased u/s transducer used for?

A

Mostly cardiac

40
Q

What are the limitations for a sonogram?

A

Large body habitus
Bowel gas
Sonographer skills, very operator dependent

41
Q

Indications for abdominal u/s

A

Gallbladder focus
General abdominal scan (gallbladder, liver, kidneys, spleen)
Excessive CT scans
Determining character of masses (cystic vs solid)
Localizing fluid collections, think ascites
Paracentesis
F/u on masses/hemangiomas/cysts
Need vascular eval and pt has IV contrast limitations
Screening for AAA
Trauma FAST scans
Pregnant pts with abdominal pain/kidney stones

42
Q

How should a pt be prepped for a gallbladder and general abd u/s?

A

NPO for at least 6 hrs to distend the gallbladder and decrease bowel gas

43
Q

What to look for in a gallbladder u/s

A

Distended or contracted?
Anything seen within the lumen?
Walls thick or thin?
Sonographic Murphy’s sign reported?

44
Q

What is the unholy trinity of a gallbladder u/s?

A

Thick walls
Sludge
Stones

45
Q

Sonographic Murphy’s sign

A

If noted in radiology report with no stones= acalculus cholecystitis
Consult the surgeon immediately

46
Q

What can be observed in a liver u/s?

A

Size
Texture
Portal and hepatic systems
Masses

47
Q

What areas are included in a FAST scan?

A 
Right upper abdomen (Morton's space between liver and right kidney)
Left upper abdomen (perisplenic and left perineal areas)
Suprapubic region (perivesical areas)
Subxyphoid region (pericardium)
48
Q

What are barium studies used to diagnose?

A 
Obstructions
Ulcers
Tumors
Transit times
Tube placement (stomach)
49
Q

Indications for barium studies

A 
Dysphagia
Obstruction in esophagus
Pt declines scope
Ulcer
Polyps/tumors
Transit time for Crohn's or celiac
Check G tube placement
50
Q

What are good positions to relax the stomach?

A

Right anterior oblique

Left posterior oblique

51
Q

Upper GI barium study is not over until _____

A

You can see the small bowel

52
Q

Indications for nuclear medicine in abdomen?

A

HIDA: to assess gallbladder function with EF; if + gallstones not usually done
Gastric emptying: gastroparesis
GI bleeding
Meckel’s scan: Meckel’s diverticulum

Radiology (4 decks)

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