Chap 1 Basic Principles Flashcards
(127 cards)
1
Q
Five different imaging modalities
A
1) X-ray
2) Computed Tomography (CT)
3) Magnetic Resonance (MR)
4) Ultrasound (U/S)
5) Nuclear Medicine
2
Q
X-rays are good for:
A
Bones and airspaces
3
Q
X-rays are bad for:
A
Soft tissue and overlapping structures
4
Q
X-ray film starts off:
A
White
5
Q
X-ray film turns ____ when hit with ionizing radiation
A
Dark
6
Q
What material makes film brighter?
A
Dense
7
Q
Different shades of gray in an x-ray
A
Water density
8
Q
Radiographic density: Darkest
A
Air
9
Q
Radiographic density: Less dark
A
Fat
10
Q
Radiographic density: Gray
A
Fluid
Blood
Soft tissue
11
Q
Radiographic density: White
A
Bone
12
Q
Radiographic density: Most white
A
Metal/Contrast
13
Q
Two-dimensional representation of a three-dimensional object
A
X-ray
14
Q
Used if patient is unable to stand or sit for a PA view
Lower quality than PA view
Back is placed next to film
Heart is magnified and borders are fuzzier
A
Anteroposterior
15
Q
Usually taken in conjunction with a PA view
Allows viewing of structures behind the heart (mediastinum) and provides three-dimensional image
A
Lateral (LAT “side view”)
16
Q
X-ray:
At an angle used mostly on limbs
A
Oblique (OBL)
17
Q
Object that is closer to the film has sharper borders
Chest is placed next to the film thereby placing most of the important structures, such as heart and great vessels, closer to the film
Heart size is minimally magnified and borders are sharp
A
Posteroanterior (PA “back to front”)
18
Q
Similar to x-ray: Shows black, white, gray depending on density
Multiple pulses (shots) -Radiation dose is high
A
CT
19
Q
CT is good for:
A
Bone
Airspaces
Some soft tissue and overlapping structures (especially abdomen in trauma)
20
Q
CT is bad for:
A
Some soft tissues (nerves, muscles, connective tissue)
Patients with retained metallic objects (causes artifacts)
21
Q
CT X-ray tube is in the:
A
Housing
22
Q
CT views:
A
Sagittal / Median
Coronal
Axial / Transverse / Cross-sectional
23
Q
Uses electromagnetism and radio frequency properties
No exposure to ionizing radiation
A
Magnetic resonance (MR)
24
Q
MR is good for:
A
Soft tissue (nerves, muscles, connective tissue, brain, joints)
25
MR is bad for:
People who cannot hold still or have ferrous metal in the body
26
Difference in CT and MR views
They're identical
27
Uses sound waves (like SONAR)
No radiation, but can't go very deep
Operator dependent
Image produced is a focused segment of the object
Ultrasound
28
U/S is good for:
Determining fluid vs solids
Abdominopelvic imaging (gallbladder, kidneys, uterus, testis)
Assessing blood flow (doppler)
29
U/S is bad for:
Things under bones (chest)
Air filled chambers
Deep things
30
Radioactive agent is given intravenously
Agent participates in physiologic processes while emitting radiation
Radiation is detected and is used to create an image showing the distribution of the agent within the body
Typical use is to detect stress fractures before being visible on x-ray
Nuclear medicine
31
Nuclear medicine is good for:
Detecting normal or abnormal physiologic processes
32
Nuclear medicine is bad for:
Showing less anatomic detail
33
U/S views
Longitudinal (sagittal)
Transverse (axial)
34
Pre-read:
Correct Patient
Correct date
Correct body part
Correct type
Image has the number of views expected
Check to see if any comparison films exist
35
What is used to assess technical adequacy?
RIP
- Rotation
- Inspiration
- Penetration
36
Look at the clavicles relative to the vertebral column
They should be equally spaced
If not properly aligned, structures will change in appearance which may mean abnormal
Rotation
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Look at the ribs:
- Should be able to count 9-10 ribs
- Posterior ribs are easier to see (more horizontal and project from the spine)
Inspiration
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Should see the ribs through the heart
Should barely see the spine through the heart
Should see pulmonary vessel near the edges of the lungs (lungs should not be completely black)
Penetration
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Lung fields completely black
Suggests pneumothorax
Over-penetrated film
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Soft tissue structures are obscured
Image appears bright suggesting consolidation (pneumonia)
Under-penetrated film
41
Chest X-ray:
ABCDE
Airway/Airspaces
Bones/Soft tissue
Cardiac Shadow
Diaphragm
Everything else
42
Order of reading a Chest X-ray
Pre-read
Technical adequacy of the film (RIP)
Systematic method (ABCDE)
43
Cardiothoracic ratio only applies to what?
PA film
44
Transverse diameter of the cardiac silhouette should not exceed __% of the transverse diameter of the thoracic cage
50%
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Film that magnifies the heart
AP
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Makes the heart horizontal and larger
Shallow inspiration
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Upper right heart border
Superior vena cava
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Lower right heart border
Right atrium
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Left heart border (from the top)
Aortic arch
Pulmonary arteries
Left atrial appendage
Left ventricle
50
Dome shaped
Right side is always higher than left
Diaphragm
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Diaphragm:
Dark and have sharp points like upside down cat ears
Costophrenic angles (sulcus)
52
Falls under "Everything Else"
Look for gastric bubble (left side)
Check for EKG leads, lines, tubings, and other missed items (four corners of the film)
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Lateral chest film:
The spine should appear:
Brighter as it proceeds inferiorly
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Retrosternal space should be:
Clear; Contains upper lungs
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Retrocardiac space should be:
Clear; contains lower lungs
56
LAT:
Middle lobe projects over:
The cardiac silhouette
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LAT:
Cardiac and diaphragmatic borders should be:
Sharp
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Imaging should _______ a suspicion
Confirm (NO FISHING)
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Imaging should _______ your treatment
Impact
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Imaging "_________" should be avoided
"Just in case"
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Your imaging request should include:
Relevant and brief patient history
Purpose for evaluation
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18-year-old non-smoker with fever, cough, dullness to percussion at left lower lobe, course crackles. Please evaluate for pneumonia.
Is an example of what?
Good imaging request
63
Common issues in primary care:
Acute foot pain
Acute ankle pain
Acute knee pain
Lower back pain
Headache
64
Ankle series is indicated if:
Has pain in the malleolar zone
AND
Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
Inability to bear weight both immediately after the injury and for four steps
65
Foot series is indicated if:
Has pain in the midfoot region
AND
Has bone tenderness at the base of the 5th metatarsal or the navicular
OR
Inability to bear weight both immediately after the injury and for four steps in the evaluation room
66
Initial imaging for stress fractures:
X-ray
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Can show abnormalities before X-ray findings
Bone scan
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What should you "Consider" for suspicion of stress fractures?
CT or MRI
69
Knee series is indicated if age is:
>55
70
Knee series indicated if:
Isolated tenderness of the patella
Tenderness at the fibula head
Inability to flex the knee 90 degrees
Inability to bear weight
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Preferred imaging for knee ligamentous injury
MRI
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Knee:
What should you do while awaiting further evaluation?
Immobilize
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Knee:
If plain radiographs are negative and you still suspect bony fracture, consider:
CT
74
Image the shoulder if:
Traumatic cause
Presence of pain
Loss of range of motion
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Shoulder:
Plain films will be able to identify:
Fractures
Dislocations
Arthritis
AC joint or SC joint injuries
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Preferred imaging for labral, ligamentous or rotator cuff injuries
MRI
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Hand:
Type of radiograph is based on:
Physical examination & Mechanism of injury
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Images for a fracture of the phalanx:
AP and true lateral views
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Hand:
When the fracture involves or is close to the joint, what view is helpful?
Oblique
80
Hand:
If the fracture cannot be delineated because of superimposed digits, such as the base of the proximal phalanx, a radiograph of what must be obtained?
Entire hand
81
All metacarpal fractures require:
AP
LAT
Oblique
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Hand fractures are described radiologically primarily by:
Location
Geometry
Comminution is present
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The most precise method of describing hand fracture is to name:
Broken bone and finger involved
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Anatomical sites for phalanges and metacarpals include:
Head
Neck
Shaft
Base
85
Fractures specifically involving the head of the distal phalanx
Tuft
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Anatomical sites of scaphoid fracture are:
Tubercle
Waist
Proximal pole
Distal pole
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Fractures involving the joint
Intra-articular
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Views of the initial evaluation of patients with chronic wrist pain
PA
LAT
Oblique
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Wrist:
PA view, wrist is held at what degree of rotation:
0 degrees (neutral)
90
Wrist:
Lateral view must be obtained with the wrist at what degree?
0 degrees
91
True lateral views show the ______ projected over the scaphoid tubercle
Pisiform
92
Wrist (LAT):
Scapholunate angle greater than ___ degrees suggests possible scapholunate instability
60
93
Wrist (LAT):
An angle of less than __ degrees suggests ulnar-sided wrist instability
30
94
Scaphoid view
Wrist in ulnar deviation
95
Clenched fist view to check:
Scapholunate joint space widening seen with ligament disruptions
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Hamate fractures
Hook view
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Radiocarpal joint is characterized by narrowing of the joint space and sclerosis of the articular surfaces
Osteoarthritis
98
Three articulations of the elbow:
Radiohumeral
Ulnahumeral
Radioulnar
99
Capitellum of the humerus with the radial head
Radiohumeral
100
Trochlea of the humerus with the trochlear notch of the ulna
Ulnohumeral
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Radial head with the radial notch of the ulna
Radioulnar
102
Elbow:
Fractures most common in falls
Distal humerus
Radial head
103
Elbow:
View frequently used to better visualize the radial head
Oblique
104
Elbow:
Fracture is not seen but there is suspicion, what view can be performed?
Coyle's
105
Elbow:
Even when a fracture cannot be identified, the presence of joint effusion in adults should be treated as:
Non-displaced radial head fracture
106
Elevated anterior fat pad
Sail sign
107
Elbow effusions are best seen on:
Lateral projection
108
Elbow:
Posteriorly, the pericapsular fat is usually hidden in the:
Olecranon groove and fossa
109
Dislocations of the elbow are named for:
The direction of the radius and ulna dislocate relative to the humerus
110
Ulnar collateral ligament is commonly found in:
Baseball pitchers
111
Lateral epicondylitis
Tennis elbow
112
Back pain:
Imaging is not indicated in the first __ weeks
4-6 weeks
113
Back pain:
Some reasons to get imaging before the 4-6 week mark:
Neurological findings (Cauda equina)
Constitutional findings
Trauma
Malignancy
Elderly
IV drug use, immunosuppression
Chronic steroid use
Nerve root irritation
Osteoporosis
114
Back pain, imaging:
Helpful for fractures or joint degeneration:
X-ray
115
Back pain, imaging:
Preferred in serious trauma:
CT
116
Back pain, imaging:
Imaging of choice with prior surgery, suspected infection, spinal cord injury, tumor, or cord compression
MRI
117
Headache, consider imaging if:
Head/neck trauma
Worse or new features (Abrupt onset of headache)
Thunderclap headache
Neurologic signs or symptoms
Headache radiating to the neck
Persistent positional headache
Temporal headache in older than 55 y/o
Suspect infection (cough, exertion, sexual activity)
118
Headache, imaging:
Preferred for trauma, to rule out hemorrhage, bone abnormalities, or prior lumbar fractures
CT
119
Headache, imaging:
Preferred for soft tissue causes such as tumors or vascular
MRI
120
Angulated fracture line
Obique
121
Runs perpendicular to the shaft of the bone
Transverse
122
Has a multiplanar and complex fracture line
Spiral
123
One bone is displaced over the other
Overriding
124
Fragments are separated by a gap
Distraction
125
Looks like a bump classified as incomplete fracture seen in children
Torus
126
Fractures by bending like a green twig classified as incomplete fracture seen in children
Greenstick
127
Have more than two fracture fragments
Comminuted
