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Oncology > Imaging > Flashcards

Imaging Flashcards

1
Q

Reasons for Imaging in the Management of Cancer

A 
Screening
Making the diagnosis
Staging
Operative planning
Response to treatment
Follow-up
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2
Q

Types of Imaging in Cancer

A 
Plain films
CT scans
Fluoroscopy
Mammography
SPECT scans
PET scans
MRI
Ultrasound
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3
Q

What are X-rays good for?

A

Lungs
Kidney/gall stones
Bones

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4
Q

X-rays not good for

A

Soft tissues

Brain

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5
Q

What do x-rays rely on?

A 
Differential absorption
Air
Fat
Water
Bone densities
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6
Q

Imaging for Bone Lesions

A

X-rays
CT scans
MRI
PET/CT

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7
Q

What are we looking at on x-rays for oncology imaging?

A 
Nature of the bone matrix
Interface of lesion & bone
Cortex intact?
What part of bone?
Benign vs. malignant
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8
Q

Define Benign Bone Lesions

A

Well-defined
No cortical destruction
No periosteal reaction

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9
Q

What are CT scans best for evaluating?

A

Subtle bone changes

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10
Q

What are MRI scans best for evaluation of?

A

Soft-tissue & infiltrative marrow lesions

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11
Q

Define Latent Bone Lesions

A

Surrounded by reactive cortical rim

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12
Q

Define Active Bone Lesions

A

Easily discernible transition without reactive rim

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13
Q

Define Aggressive Bone Lesions

A

Broad infiltrating border

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14
Q

Define Fluoroscopy

A

Continuous X-rays used to obtain real time moving images of internal structures

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15
Q

Define CT Scan

A

X-rays taken in several planes are computer processed to show images in multiple slices: AP, lateral, sagittal, x-section & even as 3D images

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16
Q

Advantages of CT Scancs

A

Differentiate structures of close physical density
Eliminates superimposition of organs
Show calcified & hemorrhagic lesions
Show in multiple planes or even as a 3D image

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17
Q

Advantages of CT Scans in Neoplastic Disease

A

Very good in the abdomen for staging
Very good for evaluation of masses in the chest
Can do virtual colonoscopy
Most intracranial neoplasms are visible

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18
Q

Disadvantages of CT Scans

A

Risk of cancer
Contrast: allergic reactions, anaphylaxis, nephropathy
Expensive
Observer variation

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19
Q

Define Pancoast’s Tumor

A

Extension of tumor at apex of the lung involving C8, T1, T2 nerves & possible destruction of ribs

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20
Q

Presentation of Pancoast’s Tumor

A

Shoulder pain radiating in the ulnar direction

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21
Q

Virtual Colonoscopy

A 
Done with CT
Requires bowel prep
No sedation needed
Not as sensitive as colonoscopy
Can't do biopsies
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22
Q

Mammography

A

Uses low energy X-rays to generate images

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23
Q

Abnormal Mammogram

A 
Needs breast examination
Further mammography for confirmation
Ultrasound for better definition
BIRAD classification
MRI with gadolinium- implants very dense
Needle/surgical biopsy may be recommended
Tissue diagnosis key
24
Q

What do nuclear scans measure?

A

Bone metabolism or remodeling

25
Nuclear Scans
``` Radio-isotope injected IV 3 hours later, the patient is scanned Provides 2D image Function test Half material goes to the bones Eliminated through the kidneys ```
26
Bone Scans
Show increased metabolic activity or increase blood flow Assess activity or known lesions Find unknown lesions Overestimates lesions MM cold scan until cortical disruption occurs
27
What does PET stand for?
Positron emission tomography
28
What can a PET be combined with?
CT | MRI
29
When are PET scans especially useful?
Lymphomas | Lung CA
30
PET Scans
Detects active, rapidly growing tumors | Higher grade malignancies detected more than benign processes
31
What does SPECT stand for?
Single Photon Emission Computer-Assisted Tomography
32
What is a SPECT scan good for?
Small spinal lesions Osteoid osteoma Osteoblastoma
33
How do MRI machines work?
Powerful magnets excite H+ protons to emit measurable electromagnetic radiation
34
Different MRI Techniques
Angiography Functional MRI Diffusion MRI CSF dynamics
35
Disadvantages of MRIs
``` Expensive Slow Claustrophobia Pacemakers, stents Small metal fragments Metal artifact Need a calm patient May be genotoxic ```
36
MRI of the Spine
Radiation free Superior for soft tissue imaging Can see subtle differences Gadolinium assists in delineating surrounding vascularity
37
Ultrasound
High frequency sound waves Reflect & echo off of tissues Processed in ultrasonic scanner Usually seen as 2D image
38
Advantages of Ultrasound
Cheap, quick, easy, safe, comfortable Shows solids, fluids, muscle, tendon, bone surface Hampered by bone, air, fat
39
Disadvantage of Ultrasound
Operator dependent
40
When to Use Ultrasound
Thyroid tumors/lesions (test of choice) | Supplement mammography
41
How to make a cancer diagnosis?
Tissue: open biopsy or needle biopsy
42
Lung Biopsy Complications
Pneumothorax | Hemoptysis
43
Which cancers primarily metastasize to the bones?
Breast Prostate Lung Kidney
44
Where are spine mets typically seen?
Base of pedicle | Unilateral destruction of pedicle "winking owl sign"
45
Define Pathologic Fractures
Occur through area of weakened bone: osteoporosis, benign cystic tumor, malignant tumor
46
PROs of X-ray
Simple Inexpensive Readily available Easily interpreted
47
CONs of X-ray
Radiation Poor tissue contrast Technician dependent 2D
48
PROs of CT Scans
Rapid 3D capability Axial imaging Good bony detail
49
CONs of CT Scans
Highest radiation Motion & metal artifact Limited ST contrast
50
PROs of Bone Scans
Images metabolic activity Very sensitive in bones Low cost
51
CONs of Bone Scans
Non-specific Poor detail Anatomic changes not visualized
52
PRO of MRI
Superior tissue resolution
53
CONs of MRI
Expensive Motion & metal artifact Can't use in some patients
54
PROs of PET/CT or MRI
Combines function & anatomy | Best for most cancers
55
CONs of PET/CT or MRI
Expensive (pre-auth)
56
PROs for Ultrasound
Very safe Inexpensive Quick
57
CONs for Ultrasound
Small field of view Technician & radiologist dependent Artifacts

Oncology (11 decks)

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