Fluoro Final Exam Review Flashcards
(111 cards)
1
Q
3 ways to inject contrast media?
A
- Indwelling
- Direct
- Intravenously
2
Q
Which exam requires direct puncture of the biliary ducts?
A
Percutaneous transhepatic cholangiogram
3
Q
Functions of the gallbladder?
A
- store bile
- concentrate bile
- secrete bile
4
Q
Purpose of an operative cholangiogram?
A
- investigate patency of biliary ducts
- functionality of sphincter
- presence of stones, stricture, or dilatations
5
Q
Advantages of laparoscopic surgery over operative cholecystectomy?
A
- less pain
- faster recovery
- less time in hospital
- smaller incisions
- cost savings
6
Q
Biliary system exams?
A
- Endoscopic retrograde cholangiopancreatography
- Percutaneous Trashepatic Cholangiogram
- Operative cholangiography
- Post-operative cholangiography
7
Q
Purpose of a diagnostic ERCP?
A
- demonstrate strictures, dilatations, or small lesions within the biliary or pancreatic ducts
- check patency of biliary and pancreatic ducts
- visualize stones or narrow duct
8
Q
Purpose of a therapeutic ERCP?
A
- removal of small lesions
- removal of stones
- dilate a blocked or narrowed duct
9
Q
Contraindications of an ERCP?
A
- pseudocyst of pancreas
- acute infections of the biliary system (pancreatitis)
- hypersensitivity to contrast
- elevated creatinine or BUN
10
Q
Dense contrast may obscure ________. What can we do to fix this?
A
Small stones. Dilute the contrast
11
Q
Prep for an ERCP?
A
NPO for at least 1hr prior to prevent aspiration
NPO for 10 hrs post to prevent irritation
12
Q
Who is a PTC performed by?
A
Radiologist, tech, and nurse
13
Q
Indications for a PTC?
A
- jaundice
- dilated ducts
- unclear as to why there is an obstruction
14
Q
Possible complications of a PTC?
A
- pneumothorax
- liver hemorrhage
- peritonitis
15
Q
Purpose of a PTC
A
To demonstrate the biliary ducts
16
Q
What images are taken for a PTC?
A
AP spot films
17
Q
What kind of needle is used for a diagnostic PTC?
A
Chiba
18
Q
Purpose of a therapeutic PTC?
A
To remove stones
19
Q
Purpose of an operative cholangiogram?
A
- patency of ducts
- functionality of sphincter
- presence of stones
- presence of strictures or dilatations
20
Q
Exposures taken for an operative cholangiogram?
A
- AP
- RPO: 15-20 deg
21
Q
Where is an operative cholangiogram performed?
A
In the OR by the surgeon, surgical asepsis
22
Q
Where is a post-operative cholangiogram performed?
A
In the radiology department
23
Q
What may be required to fill the intrahepatic ducts with contrast?
A
Trendelenberg
24
Q
What exam can be done if patient is contraindicated for an ERCP?
A
PTC
25
Which part of the kidney is more posterior?
Superior
26
How much do the kidneys move between inspiration and expiration?
1-4cm
27
How much do the kidneys move from supine to upright?
5cm
28
At what vertebral levels do the kidneys lie?
T12-L3
29
Urinary system exams?
- KUB
- IVU
- Retrograde urography
- Cystography
- VCUG
- PCN
30
Indications for a urinary study?
- renal calculi
- chronic urinary tract infections
- urethral strictures
- anatomic evaluation of the renal pelvis, calyces, and ureters
31
Locations of ureter contrictions?
- Vesicoureteral junction
- Ureteropelvic junctions
- Brim of pelvis
32
What modality is becoming more common to discover kidney stones? Why?
CT
- safe, less invasive, no contrast used
- accurate
- disadvantage is high dose and not always available
33
Prep for urinary studies?
- NPO 8hrs prior
| - bowel cleansing required to avoid gas and fecal shadows
34
Purpose of the KUB?
- verify patient prep was successful
- determine exposure factors
- verify position of structures
- detect any abnormalities
35
Positioning for KUB?
- supine
- CR at crests (L4)
- collimate to ASIS
- include kidneys to symph
- expose on expiration
- male shielding below superior margin of symph
36
Purpose of an IVU?
- visualize collecting portion of the urinary system
- assess functional ability of the kidneys
- evaluate the urinary system for pathologies or anatomic anomalies
37
Indications for an IVU?
- abdominal masses
- renal tumour/cysts
- urolithiasis
- pyelonephritis
- hydronephrosis
- trauma
- pre-op evaluation
38
Contraindications for IVU?
- renal failure
- renal insufficiency
- renal hypertension
- CHF
- prior contrast reaction
- anuria
- sickle cell anemia
- multiple myeloma
- Pheochromocytoma
39
What medication must be stopped for 48hrs post-contrast?
Glucophage
40
Routine projections for an IVU?
- 30sec to 1 min AP (nephrogram, kidneys only)
- 5 min AP kidney
- 10 min AP (full)
- 20 min obliques (full)
- Post void
41
AP kidney positioning
- CR midway between xiphoid and crests (L1)
- bottom of IR at crests (24x30)
* include time marker
42
Oblique positioning for IVU?
- posterior obliques
- 30 deg rotation on patient
- CR at level of crests, 10 cm lateral to elevated side
- expiration
* time marker
43
Why do we use compression?
Allows for visualization of the renal pelvis and calyceal filling and proximal ureters
44
Contraindications of compression?
- stones
- recent surgery
- pelvis mass/tumor
- aneurysms
- trauma
45
Purpose of retrograde urography?
- to determine location of undetected stones or other obstruction
- to view renal pelvis and calyces for signs of infection or structural defect
46
Where is retrograde urography performed?
In the OR by a surgeon, surgical asepsis
47
Images for retrograde urography?
AP, no set time interval, urologist instructions
48
Indications for bladder exams?
- vesicoureteral reflux
- recurrent UTI
- neurogenic bladder
- bladder trauma
- fistulas
- urethral stricture and posterior urethral valves
49
Purpose of retrograde cystography?
-rule out tumours, stones, trauma, and inflammatory diseases of the bladder
50
Where is retrograde cystography performed?
In the x-ray department by a radiologist
51
What happens if you try to introduce contrast under pressure to the bladder?
It could rupture
52
Cystogram projections?
- AP axial bladder
- Posterior obliques
- PA axial bladder
- Lateral
53
AP Axial bladder positioning?
- supine
- 10-15 deg caudad
- CR 5 cm above symph
- expiration
- urinary bladder not superimposed by bones
- distal ureters and proximal portion of urethra demonstrated
54
PA Axial Bladder
- prone
- 10-15 deg cephalad
- CR 2.5cm distal to tip of coccyx
- expiration
55
Posterior oblique bladder positioning?
- 40-60 deg patient rotation
- CR 5cm above symph and 5cm medial to elevated ASIS
- expiration
- distal ureters (UV junction on upside), bladder, and proximal portion of urethra demonstrated
56
Lateral bladder positioning?
- true lateral
- CR 5cm above symph and 5cm posterior to symph
- expiration
- anterior, posterior, and base of bladder
57
Purpose of a VCUG?
Evaluate patients ability to void
58
Difference in positioning for a male vs. a female for a VCUG?
Female: AP or slight oblique
Male: 30 deg RPO
59
Purpose of a Percutaneous catheter nephrostomy?
- drainage
- drug instillation
- instrument insertion
60
Complications of a PCN?
- infection
- catheter obstruction
- catheter dislodgment
- hemorrhage
61
What is the follow up of a PCN called?
Nephrostography
62
Methods of stone removal?
- extracorporeal shock wave lithotripsy
- laser stone fragmentation
- percutaneous nephrolithotomy
63
Extracorporeal shock wave lothotripsy
- non invasive
- stones must be less than 2mm in size
- uses shock waves from an electrical source to pulverize stone
- ureter must not be obstructed
64
What are taken before a ESWL?
- prelim abdomen film
| - IVU
65
Where is Laser stone fragmentation performed? What does it entail?
In the urology suite under general anesthetic
| -scope in inserted into ureter and laser is blasted at stone
66
What is percutaneous nephrolithotomy?
- incision made into kidney to remove the stone
- basket extraction to remove small stones
- ultrasonic lithotripter to break up large stones
67
Purpose of a hysterosalpingogram?
Size, shape, and position of uterus and tubes
68
Most common indication of a hysterosalpingogram?
Infertility
69
What is fluoroscopy?
Real-time dynamic viewing of anatomical functions using x-ray
70
What effect does increasing kVp have on dose?
- decrease dose if mA remains the same because less if absorbed
- increase dose because we have less penetrability and will need to compensate by increasing mA
71
List come procedures that would utilize fluoroscopy?
- BE
- SBFT
- Esophageal studies
- Arthrograms
- Angiography
- Biliary system exams
- Genitourinary system exams
- OR cases
- Pacemaker insertions
- Hip pinnings
72
Normal range of kVp used to perform fluoro exams on adults?
75-110 kVp
73
How does SID affect dose
-increased SID = decreased dose
74
How does OID affect dose?
-increased OID = increased dose because decreased distance to source
75
What are quantity and quality?
Quantity: amount of x-ray photons, mA
Quality: strength of x-rays, kVp
76
How does focal spot affect dose?
It doesn't
77
What is the most effective mechanical methods of decreasing patient dose?
Collimation
78
How does filtration effect dose?
-increased filtration = decreased dose because it absorbs low energy photons
79
Why can't we achieve the ideal combo of technical factors?
We have to maintain a balance between dose and image quality
80
How do grids affect dose?
Grid = increased dose because we have to raise out mA
81
What are stochastic effects?
"Probabilistic"
- no threshold
- increased chance with increased dose
82
What are non-stochastic effects?
"Deterministic"
- have a threshold
- increased severity with increased dose
83
What is a somatic effect?
The effects only take place in the person irradiated
84
4 main components of the I.I
1. Input phosphor: converts radiation to light
2. Photocathode: converts light to electrons
3. Electrostatic Focusing lenses: direct electrons towards anode
4. Anode: attracts electrons emitted from photocathode
5. Output phosphor: receives electrons, emits light
6. Glass envelope: maintains vacuum
85
How does mag mode affect dose?
Increased it because the image appears dimmer due to decreased photoelectrons on the output phosphor so we need to increase out mA to compensate
86
When the I.I is closest to the patient, the dose _______?
Decreases
87
What are the advantage of digital fluoro over conventional that can be used to decrease dose?
- pulsed fluroscopy
- last image hold
- pulsed progressive fluoro
88
When is cinefluorography used? Why is it bad?
- cardiology
- neuroradiology
- uses a higher tube voltage and current
89
Purpose of the I.I?
Increase the brightness on the screen
90
Benefits of an I.I?
- increased brightness
- rads don't need to adjust to dark
- improves visual acuity
- reduces technical factors
91
Advantages of mag mode
- increased spatial resolution
| - increased contrast resolution
92
How does pulsed fluoro work?
When the beam is off the output screen in scanned and the image appears on the monitor, radiation is pulsed back on for the next image
93
As value increases the I.I flux gain _______?
Decreases
94
Air kerma exposure rate limitation?
- With ABC: 50mGy/min
| - Without ABC: 100mGy/min
95
Purpose of filtration
To reduce skin dose
96
Minimum filtration?
2.5mm Al
| With I.I, 3.0mm or higher
97
What is a mandatory function that all units must have as stated in the SC35?
Chronometer
98
Max entrance skin exposure rate?
-100mGy/min
99
Intensity at tabletop should not exceed?
-21mGy/min
100
Units with high level control may have a skin exposure rate of?
-200mGy/min
101
What is DAP
Dose area product: reflect the dose and area of radiation
102
DAP increases as field size _______
Increases
103
What are DRLs used for?
To promote better control of patient exposure, used as a guideline not a limit
104
DRLs
Abdomen: 20-70Gy/cm
BE: 30-60Gy/cm
Coronary Angriography: 35-75Gy/cm
105
What is high level fluoro used for?
Interventional procedures: drainage, biopsy, angiography
106
High level fluoro dose is controlled by?
Frame speed. Lower frame speed = lower dose
107
To best monitor effects in dose we must be diligent in?
- patient monitoring
- radiation dosimetry
- accurate record keeping of dose levels
108
Protective barriers?
- Detectors slot cover: 0.25mm Pb
- Protective curtain: 0.25mm Pb
- I.I housing: 2mm of Pb
109
Occupational dose comes from?
- long exposure times
- failure to use protective curtain
- extensive use of cine as a recording medium
110
We can reduce tech dose by?
- rotating tech sched
- use lead aprons
- use mobile shields
- use bucky slot shielding devices
- keep hands out of beam
- be aware of body position with respect to beam
- stand behind control booth when possible
111
Q/C
- Exposure linearity: constant output for various mAs combos, within 10%
- Exposure reproducibility: sequential exposures, within 10%
- Protective apparel testing: cracks, tears, or holes
