Advanced Chest Imaging, Abdominal Imaging, Specialty Abdominal Imaging Flashcards Preview

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Flashcards in Advanced Chest Imaging, Abdominal Imaging, Specialty Abdominal Imaging Deck (52):
1

Pregnancy tests and radiology

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

2

Chest trauma plain films- when to get, components?

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

3

What can be seen on plain films for chest trauma?

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

4

Indications for CT chest

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

5

When to get a CT chest without contrast for chest

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

6

Labs you must get before radiologist will give IV contrast

BUN
Creatinine
GFR

7

When to get a CT chest with contrast for chest

Trauma
Assess aneurysm
Dissection
Radiologist preference

8

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

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

9

What size needle to use for CT angiography

20g or higher, can't use EJ IV access

10

What will a cardiac pt need for a CT angiography?

May need a BB

11

When to use CTA for chest

PE
CAD
Trauma

12

Types of u/s

Echo including TEE
FAST
Pericardial effusion
u/s guided thoracentesis

13

Echo indications for chest

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

14

When to use chest u/s

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

15

When to use nuclear medicine for chest imaging?

V/Q lung scan
Bone scan

16

When to use MRI for chest imaging?

Radiologist recommends

17

When to use PET for chest imaging?

Radiologist/oncologist recommends

18

Why do a V/Q?

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

19

Purpose of bone scan

For skeletal abnormalities
Fx age
Bony mets

20

Types of plain film abdominal imaging

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

21

Why a PA chest for an abdominal complaint?

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

Indications for plain film abdominal studies

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

23

Indications for abdominal CT

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

When to use no contrast in abdominal CT

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

When to use PO and IV contrast with an abdominal CT

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

When to use IV contrast only with an abdominal CT

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

When to get an abdominal CT with and without IV contrast

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

28

What does a CT abdomen cover?
CT pelvis?

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

When should one get a CT pelvis only?

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

What to get CTA of abd/pelvis

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

31

Reasons to get an u/s of the abdomen

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

32

What is u/s jelly used for?

To fill the air gap between transducer and skin

33

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

More superficial

34

What is gain in an u/s?

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

35

How should the best u/s images be obtained?

Use depth and gain

36

Linear u/s transducer frequency

12 MHz

37

Curved u/s transducer frequency

4 MHz

38

Phased u/s transducer frequency

7 MHz

39

What is a phased u/s transducer used for?

Mostly cardiac

40

What are the limitations for a sonogram?

Large body habitus
Bowel gas
Sonographer skills, very operator dependent

41

Indications for abdominal u/s

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

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

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

43

What to look for in a gallbladder u/s

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

44

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

Thick walls
Sludge
Stones

45

Sonographic Murphy's sign

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

46

What can be observed in a liver u/s?

Size
Texture
Portal and hepatic systems
Masses

47

What areas are included in a FAST scan?

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

What are barium studies used to diagnose?

Obstructions
Ulcers
Tumors
Transit times
Tube placement (stomach)

49

Indications for barium studies

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

50

What are good positions to relax the stomach?

Right anterior oblique
Left posterior oblique

51

Upper GI barium study is not over until _____

You can see the small bowel

52

Indications for nuclear medicine in abdomen?

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