Head and Neck Radiology

Question 1

RECAP- which types of radiology don’t involve any radiation?

Answer 1

Ultrasound
MRI

Question 2

What might plain radiography (x-rays) be used to visualise in head and neck?

Answer 2

Maxillofacial views
OTP (Dental assessment).

Question 3

What is the anatomical barrier between the oropharynx and the oral cavity?

Answer 3

Anterior pillars of tonsillar fossa

Question 4

Where is the most common place for a foreign body to end up if entry via mouth e.g. fish bone?

Answer 4

Pyriform sinuses

Question 5

Name the type of x-ray used on the lower face, teeth and jaw.

Answer 5

OTP

Question 6

Which materials are usually used for contrast studies?

Answer 6

Barium and iodine based water soluble contrast swallows

Question 7

What is a common factor of the contrast swallows?

Answer 7

They’re radiopaque and can show structure of parts of ther body you might not usually see

Question 8

What is FOSIT?

Answer 8

Feeling Of Something In Throat

(first letter of each word = FOSIT)

Question 9

How is the complaint of FOSIT investigated?

Answer 9

Often using flexible nasoendoscopy

Question 10

Which material is okay when used in contrast studies in the GIT but not okay when outside the GIT?

Answer 10

Barium

Question 11

What are sialograms used for?

Answer 11

Using a contrast medium to assess ducts within a salivary gland

Question 12

Name an abnormality that can be picked up in the salivary glands when using sialogram.

Answer 12

Punctate sialectasis- looks like lots of little dots

Question 13

Which condition is punctate sialectasis associated with?

Answer 13

Sjogren’s syndrome

Question 14

What is the presentation of Sjogren’s syndrome?

Answer 14

Dry mouth, dry eyes, pain in joints (athralgia), abnormal salivary ducts

Question 15

What is videofluroscopy useful for?

Answer 15

Assessing function of someone’s swallowing.

Question 16

Which other healthcare specialist will be present when doing a videofluroscopy?

Answer 16

Speech therapist

Question 17

When may someone’s normal swallowing mechanism become abnormal?

Answer 17

After stroke
Post-op

Question 18

After a laryngectomy, it is a lot more difficult to speak and patients can use oesophageal speech. However, it is a lot quieter than normal speech. Name one way oesophageal speech can be enhanced.

Answer 18

Insertion of a Blom-Singer valve

Question 19

List some of the advantages of Ultrasound.

Answer 19

No radiation
Portable
Safe

Question 20

Which type of structure is ultrasound good for?

Answer 20

Soft tissues, or if anything has fluid in it when it shouldn’t

Not good for bone or gas-filled areas like bowels

Question 21

What type of ultrasound is used to look at vascularity?

Answer 21

Doppler ultrasound

Question 22

When else may ultrasound be used?

Answer 22

To guide fine needle aspirations
To characterise lymph nodes
Investigation of hyperparathyroidism

Question 23

What tests would be done if you suspect your patient has primary hyperparathyroidism?

Answer 23

Check calcium levels
If raised, check serum parathormone level.

Question 24

What would a patient with primary hyperparathyroidism present with?

Answer 24

‘Stones, moans, bones and groans’

General aches, kidney stones, etc.

Question 25

What is a sestamibi scan?

Answer 25

Nuclear medicine scan, used to evaluate function of parathyroid glands

Question 26

What is the substance and the radioisotope used in sestamibi scanning?

Answer 26

Sestamibi= substance Radioisotope= technecium-99

Question 27

How is the outer ear best assessed?

Answer 27

Otoscopy

Question 28

How is the middle ear best assessed?

Answer 28

CT (lots of bony structures)

Question 29

How in the inner ear best assessed?

Answer 29

MRI (soft tissue)

Question 30

What type of radiology will show up sinuses of the brain well?

Answer 30

CT

Question 31

If a subperiosteal collection is seen on radiology, what needs to be done?

Answer 31

Pus has leaked from ethmoid sinus into lamina papyracea to form a subperiosteal abscess. Needs to be surgically treated or could cause blindness due to stretching of the optic nerve.

Question 32

Upon radiography, you see a tumour sitting in the carotid bifurcation. Which type of tumour is this very likely to be?

Answer 32

Carotid body tumour

Question 33

What is important to consider when investigating a carotid body tumour?

Answer 33

10% of these tumours are bilateral so always important to check the other side

Question 34

Which contrast is most commonly used in MRI?

Answer 34

Gadolinium

Question 35

Who cannot have an MRI?

Answer 35

Those with metal replacements or any metal within or on them at all. Those who are claustrophobic.

Question 36

What is the ideal imaging modality for the assessment of temporomandibular joints?

Answer 36

MRI

Question 37

Describe what happens in PET scanning.

Answer 37

Use of radioisotope which emits positrons, often taken up by cancer cells

Question 38

If a PET scan shows an area which has taken up a lot more of the contrast, it doesn't automatically mean it's cancer. What else may it be?

Answer 38

Area of infection/inflammation