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CPS > Radiography > Flashcards

Radiography Flashcards

1
Q

Outline the restraint of small animals for radiography

A
  • Chemical and physical
  • Sedation/GA
  • Positioning aids
  • Never manual restraint
  • Positioning may depend on condition-
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2
Q

Outline the restraint of large animals for radiography

A
  • Most radiographed sedated and standing
  • Manual restraint usually required
  • Occasionally GA for some body areas e.g. pelvis
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3
Q

What is the importance of movement blur in radiography?

A
  • Leads to poor image quality

- Can be due to voluntary or involuntary movements

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4
Q

How can movement blur be minimised?

A
  • Correct machine settings
  • Use of good restraint
  • Short exposure (increase mA, decrease exposure time)
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5
Q

Outline sedation for radiography

A
  • Suitable for most thoracic and abdominal radiography
  • May be used for some MSK studies
  • A2A and butorphanol commonly used
  • Close monitoring required, oxygen supplementation often also important
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6
Q

Outline general anaesthesia for radiography

A
  • Some MSK radiography as require critical positioning
  • Required for good quality, inspiratory thoracic radiographs
  • Most contrast studies except oral barium
  • May be safer for patient vs sedation
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7
Q

What are the Roentgen signs?

A
  • Number
  • Location
  • Size
  • Shape
  • Margination
  • Radiopacity
  • Internal architecture and function in some cases
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8
Q

What are the characteristics of a good radiograph?

A
  • Accurate portrayal
  • Easy perception (sharp shadows, wide range of shades of grey)
  • No misleading artefacts
  • Consistent results
  • No unnecessary risks taken
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9
Q

Outline positioning for radiogrpahy

A
  • Part of interest as close as possible to cassette to minimise distortion
  • Use standard radiographic positions first
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10
Q

How is axial rotation in the thorax assessed?

A
  • Look at rib heads overlying as opposed to the ribs

- The caudodorsal rib heads should be superimposed

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11
Q

Outline centring for radiography

A
  • Centre primary beam over area of interest

- Means that x-rays will go through area of interest vertically minimising distortion

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12
Q

Outline the importance of collimation for radiography

A
  • Scatter contributes to general image opacity and increases radiation hazard
  • Collimation means minimum size beam is used and so reduces scatter
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13
Q

What is the collimation required for joints and long bones?

A
  • Joints: include associated 1/3rd of adjacent bones

- Long bones: include whole bone including both adjacent joints

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14
Q

Outline how to appraise collimation

A
  • Primary beam must be contained within area of cassette, so 4 unexposed borders should be visible if are not shuttered by digital machine -
  • Collimation described by number of unexposed borders seen on plate, given as percentage i.e. 0%, 25%, 50%, 75%, 100%
  • Then describe how closely the image has been collimated to the area of interest
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15
Q

Outline the considerations regarding exposure factors in radiography

A
  • Cannot tell correct exposure from visual appearance of a digital image
  • Need to use minimum exposure possible
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16
Q

Why are grids used in radiography?

A
  • X-ray scatter more significant with thicker animal
  • Presents safety issue and poorer image quality
  • Grids reduce scattered radiation reaching the cassette and improve radiographic contrast
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17
Q

How do grids reduce the scattered radiation reaching the cassette?

A
  • Alternating strips of palstic and leda in a thin sheet
  • Filter out x-ray photons not passing in a forward direction
  • Absorbs proportion of primary beam
  • Width and height of lead strips determine how much scattered radiation is filtered
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18
Q

Describe how to use a grid in radiography

A
  • Only legally allowed for body regions greater than 10-15cm thick
  • Placed between patient and cassette
  • Focused grids must be aligned with centre of primary beam, correct way up and correct film focal distance used
  • Increase exposure (called grid factor, usually increased by 2-3 times)
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19
Q

What are the different types of grids available?

A
  • Parallel
  • Focused
  • Pseudofocused
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20
Q

Describe the labelling of a radiographic image

A
  • Patient and date may be entered into computer and embedded in digital image file and linked to radiograph
  • Side markers should always be exposed on the image
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21
Q

Why is radiography an important part of many imaging work-ups?

A
  • Time and cost effective
  • Easy
  • Can be easily submitted for a second opinion (teleradiology)
  • Useful where bone or air/gas is present
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22
Q

What are the disadvantages of radiography?

A
  • Less useful where fluid and soft tissue structures are present and in contact
  • Patients need to be well restrained
  • Good radiographic technique needed for diagnostic images
  • Hazards of ionising radiation to personnel
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23
Q

What conditions are likely to give the best imaging results?

A
  • Chonic, and where clinical signs are severe or persistent/recurrent despite treatment
  • Significant changes will have taken place in the patient
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24
Q

What is the general principle for radiographic views taken and why?

A
  • 2 perpendicular orthogonal views
  • To fully evaluate any body area
  • Certain views may hide certain pathologies
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25
Q

What are the routine views taken for the thorax for:

a: routine radiography
b: lung metastasis screening
c: specifically lung pathology?

A

a: RLR and DV
b: RLR, LLR and DV or VD
C: RLR (+/- LLR) and VD

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26
Q

What are the routine views taken for abdominal radiography?

A

RLR or LLR and VD

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27
Q

What are the routine views taken for pelvic or spinal radiography?

A

RLR or LLR and VD

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28
Q

What are the routine views taken for limb radiography?

A

Mediolateral and CrCd/CdCR/DP/PD

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29
Q

What are the routine views taken for skull radiography?

A

RLR or LLR and DV

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30
Q

Why are 3 views taken when screening for lung metastases?

A
  • Lung closest to table will collapse

- This will hide any soft tissue pathologies

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31
Q

Why is a VD view better for abdominal radiography?

A

Allows the intestines to spread out more and so improves visualisation

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32
Q

Why is a DV view commonly used for imaging of the skull?

A

Easier to get the skull and spine straight on DV

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33
Q

What views are taken for limb radiography of the horse?

A
  • 4 orthogonal views
  • Lateromedial
  • Dorsopalmar/dorsoplantar
  • 2x45 degree oblique views
  • e.g. for carpus: DorsoLateral-PalmaroMedial Oblique (DLPMO) and DorsoMedialPalmaroLateral Oblique (DMPLO)
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34
Q

What is adjusted to improve the contrast of a radiograph?

A

kV (changes the power of the beam and so changes the proportions that x-rays can penetrate through tissues)

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35
Q

When should thoracic images be taken in relation to the patient’s breathing?

A

At peak inspiration to prevent the diaphragm obscuring the view, and to prevent the lung fields appearing opaque where they are not

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36
Q

When should abdominal images be taken in relation to the patients breathing?

A

At the expirational pause to ensure there is enough space in the abdomen for the intestines to spread out

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37
Q

What is the purpose of radiographic contrast studies?

A

Provide increased detail of organ size, shape, position, internal detail and sometimes function

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38
Q

Outline the properties of negative contrast agents

A
  • Low physical density agents
  • Radiolucent appearance
  • Air, gases
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39
Q

Outline the properties of positive contrast agents

A
  • High atomic number therefore high radiographic opacity
  • Radiopaque on radiographs
  • E.g. barium, meglumine diatrozoate, iohexol
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40
Q

List the ideal properties of radiographic contrast agents

A
  • Differ from tissues under examination in terms of capacity to absorb x-rays
  • Accurately delineate the body part being examined
  • Be neither toxic nor irritant
  • Persist for the duration of the study
  • Be totally eliminated afterwards
  • Easily administered
  • Cost effective
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41
Q

Why should a plain (survey) radiograph be taken before a contrast study?

A
  • Assess adequate radiographing technique
  • Inform if contrast media is contra-indicated
  • May give a diagnosis
  • Assess patient preparation e.g. presence of faeces
  • Decide on suitable technique
  • Comparison with study films
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42
Q

How many views should be taken for contrast studies?

A
  • 4
  • Contrast agent moves with gravity, each view will put the contrast agent into a different position
  • Will show or hide different things
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43
Q

Where are negative contrast agents commonly used?

A

Bladder and Gi tract

44
Q

What are the advantages of negative contrast studies?

A
  • Cheap
  • Quick
  • Convenient
  • Relatively safe
45
Q

What are the disadvantages of negative contrast studies?

A
  • Poor mucosal detail if used alone
  • Air slowly eliminated from the body which may confuse later studies
  • Theoretical risk of air embolus in blood strem e.g. if have ulceration
46
Q

What are barium sulphate studies common used for? How is it administered?

A
  • GI contrast studies

- Administered as suspension, paste or mixed with food

47
Q

What are the advantages of barium sulphate contrast studies?

A
  • Low toxicity
  • Inert
  • Excellent mucosal detail
  • Therapeutic for V&D
  • Relatively cheap
48
Q

What are the disadvantages of barium sulphate contrast studies?

A
  • Care with aspiration, cannot be used under GA
  • Cause granulomatous reaction in the lungs if refluxed
  • Irritant if enters body cavities so care with suspected perforation
49
Q

What are water-solube iodine preparation contrast studies commonly used for?

A
  • Cardiovascular system
  • Urinary tract
  • Joints
  • Salivary glands
  • Tear ducts
  • Fistulas/sinuses
  • GIT
  • Myelography
50
Q

What are the 2 types of water soluble iodine preparations?

A
  • Non-ionic
  • Ionic
  • (also gastrointestinal preparations)
51
Q

What are ionic water soluble iodine preparation contrast studies used for?

A
  • Suitable for IV administration, or directly administered
  • NOT myelography
  • e.g. meglumine diatrozoate
52
Q

What are non-ionic water soluble iodine preparation contrast studies used for?

A

Suitable for myelograpy and any other use, recommended for all applications as has few side effects vs ionic
- e.g. iohexol

53
Q

What are the advantages of water-soluble iodine preparation contrast studies?

A
  • Versatile (can be injected IV or directly administered)

- Rapidly absorbed and excreted by the liver if leak into body cavity and blood stream

54
Q

What are the disadvantages of water-soluble iodine preparation contrast studies?

A
  • Ionic are hyperosmolar so get unprelant side effects if conscious (nausea, vomiting)
  • Ionic are irritant if injected direclty
  • Large doses of iodine are toxic
  • Contra-indicated IV in hypovolaemia, hypotension, cardiac or severe renal failure
  • Rarely may cause iodine-induced acute renal failure
55
Q

What is myelography?

A

Contrast radiography of the spine and subarachnoid space

56
Q

What is intravenous urography?

A
  • Excretion urography

- iv injection of contrast excreted by kidneys

57
Q

Outline cystography

A
  • COntrast radiography of the bladder
  • Can be positive contrast (infusion of positive contrast into bladder)
  • Pneumocystography: infusion of air into bladder
  • Double contrast cystography: infusion of positive contrast into bladder followed by air
58
Q

What is cardio-angiography?

A

Contrast radiography of heart and blood vessels

59
Q

What sis arthrography?

A

Contrast radiography of the joints

60
Q

What is dacryocystography?

A

Contrast study of the lacrimal sacs

61
Q

What are the advantages of advanced imaging methods e.g. CT and MRI?

A
  • Avoid superimposition as give cross sectional images
  • Superior to radiography and ultrasonography for some conditions
  • Useful for surgical planning
62
Q

What are the disadvantages of advanced imaging methods e.g. CT and MRI?

A
  • Radiography and ultrasonography may be more efficient
  • Long periods of restraint needed
  • High cost
  • Limited availability
63
Q

What regions/tissues is CT particularly useful for?

A
  • Bone
  • Nasal cavities
  • Middle ear
  • Some joints e.g. elbow
  • Pharynx
  • Lungs
  • Thoracic and abdominal masses
  • Portosystemic shunts (angiography)
64
Q

What regions/tissues is MRI particularly useful for?

A
  • Soft tissues
  • Nervous system
  • Middle ear
  • Soft tissue masses e.g. in the head
  • Some joints e.g. shoulder, stifle and muscles/tendons
65
Q

What are the key principles of a radiological report?

A
  • Must enable someone else to look at radiograph and understand what you are talking about
  • Focus on important points
  • Use radiographic (Roentgen) signs for accurate descriptions
  • Normal structures mentioned
  • All abnormalities listed and prioritised in terms of likely significance
  • Differential diagnoses ordered in terms of likelihood
  • Consider further diagnostic tests
66
Q

What are the requirements for radiographic viewing equipment?

A
  • Must have enough luminance and spatial resolution
  • Applies to all screens for diagnosis
  • Good quality, high brightness and high resolution LCD screens fill requirements
67
Q

Outline the standardised orientation for radiograph interpretation

A
  • Cranial portion towards left of image
  • Proximal towards top of image
  • VD: cranial to top, look at image as though looking at patient i.e. left marker on the right
  • Lateral: dorsal edge to top of image, cranial to the left
68
Q

Outline the basic principles of radiographic image interpretation

A

1: Put radiograph in correct orientation
2: Assess whether or not the radiograph is of diagnostic quality
3: Make observations on what can be seen
4: Summarise and establish differentials and interpretation
5: Assess whether any other tests are needed in order to establish a firm diagnosis

69
Q

Outline the initial observation stage of radiograph interpretation

A
  • Simply describe
  • Be systematic, work outside in
  • Roentgen signs
  • Comment on normals
  • Comparison to normal if available
  • Do not let clinical signs influence observations
  • Be aware of possible superimposition
  • Evaluate visibility of borders
  • Consider potential shadowing/border obliteration
70
Q

Outline the summarising and differentials stage of radiographic interpretation

A
  • Summarise all observations
  • Differentials should lead on from conclusions
  • Rank in order of likelihood
  • Connect observations to clinical signs
  • Eliminate differentials as a result of radiograph
  • Unusual findings usually unusual presentation of common condition
  • Usually single differential covers all or most abnormalities, more likely to be several conditions in old patients
71
Q

List some common pitfalls in radiographic interpretation

A
  • Search errors
  • Lack of methodical search
  • Judgement or analysis errors
  • Not taking enough time
  • Not considering effects of limitations of radiographic technique
  • Not looking at all of radiograph
  • Distraction by an obvious lesion
  • Not knowing normal radiographic anatomy
  • Allowing clinical details to influence observation
  • Not considering clinical details of case when formulating differentials list
  • Not placing differentials in likelihood order
72
Q

Explain how under-reading a radiograph may occur

A

Failure to recognise poor technique, lack of knowledge, committing to a diagnosis before radiography, interpreting a certain combination of signs as indicating a specific diagnosis

73
Q

Explain how over-reading a radiograph may occur

A
  • Misinterpreting normal anatomy e.g. fat separating lungs from thoracic wall misinterpreted as pleural effusion
  • Classification of incidental findings as signficiatn
  • Mistaking artefacts for pathology
  • Faulty reasoning (e.g lesion identified but incorrectly localised)
74
Q

Describe the somatic effects of radiation on individuals

A
  • Skin erythema
  • Bone marrow hypoplasia
  • Testicular/ovarian sterility
  • Abortion
  • Cataracts
  • Life-shortening with very high doses
75
Q

Outline some genetic effects of radiation

A
  • Increased risk of DNA mutation and inherited abnormalities

- Carcinogenic effects

76
Q

What cell types and therefore tissues and individuals are most susceptible to the risks of radiation?

A
  • Rapidly dividing cells
  • Bone marrow, gonadal tissue, germinal layers of skin/GIT
  • Persons under 18, pregnant women/foetus
77
Q

Outline the risk from scattered radiation to staff

A
  • Scatter can travel in any direction
  • Consists of lower energy radiation produced in the patient’s body tissues
  • Same risks as radiation
78
Q

Outline gamma scintigraphy

A
  • Aka physiological imaging, commonly used for MSK diseases in horses
  • Injection of unstable radioactive nucleotide (usually technetium 99m) into patient
  • Decays, releasing gamma rays
  • Detected using gamma camera, converts into light and produces computer image
  • Uptake in areas of disease increased by carrier e.g. methylene diphosphonate (MDP_
79
Q

Outline safety issues related to gamma scintigraphy

A
  • Animals injected with radioactive substance
  • Technetium has a short half life (6 hours) and decays rapidly (12-48 hours)
  • Minimise handling during procedure and isolate after
  • Excreted urine must be caught and stored for 48 hours
80
Q

Describe radioiodine treatment

A
  • Treatment for feline hyperthyroidism
  • Iodine 131 injected and concentrated in thyroid gland
  • Emits beta-particles and gamma rays, only travel a few mm in tissue
  • Half life of 8 days
81
Q

Outline the safety issues associated with radioiodine treatment

A
  • Radioiodine excreted from body in urine mostly so must be caught and stored until safe
  • Cat is a radiation hazard so must be isolated and hospitalised for at least 14 days
82
Q

What legislations control the use of ionising radiation?

A
  • Ionising Radiations Regulations 2017 (governs use of radiation in workplace)
  • Ionising Radiation (Medical Exposure) Regulations 2018
83
Q

Outline the main points of the legislation relating to ionising radiation

A
  • Notify Health and Safety Executive if practice owns/uses an x-ray machine
  • Appoint Radiation Protection Adviser and Radiation Protection Supervisor
  • Define and identify controlled area
  • Draw up and follow local rules
  • Justify need for radiation
  • Minimise exposure to personnel (ALARP)
  • No dose limit should be exceeded
84
Q

Describe the Radiation Protection Advisor (RPA)

A
  • External to practice, expertise in radiation safety
  • Advanced knowledge of radiation safety e.g. Radiation physicist, Veterinary Diploma holder
  • RPA Certificate of Competence
  • Initially helps design and set up radiography facilities
  • Establishes Local Rules
  • Annual visits for monitor safety and advice on: room design, layout, shielding, siting and use of equipment, local rules, dosimetry
85
Q

Describe the Radiation Protection Supervisor (RPS)

A
  • Member of staff within practice
  • Responsible for day-to-day supervision and enforcement of rules
  • Makes sure Local Rules are followed
  • Keeps Local Rules and paperwork up to date
  • Understands legal requirements
  • Ensures radiation doses are kept to a minimum
  • Manage radiation emergencies
  • Consults with RPA where necessary
86
Q

Describe the controlled area for radiation

A
  • Area of risk of significant radiation exposure
  • Determined by RPA
  • Dependent on facilities and type of radiographic studies
  • Clearly defined with warning signs
  • Extends 2m from primary beam if performed outdoors
  • Usually constitutes x-ray room in small animal practice
87
Q

What materials stop x-ray beams?

A
  • Primary beam: 4.5 inches of brick (double layer of brick), or 1 mm lead
  • Scattered radiation: single layer of brick
  • Not stopped by wood or glass
88
Q

Describe the Local RUles of rradiation

A
  • Code of Conduct for performing radiography
  • Placed in easily visible place
  • Read and understood by every member of staff involved in radiography
  • Details equipment, procedures and access restrictions
  • Lists RPA, RPA and any staff involved in radiography
  • Defines control areas
  • Includes written arrangements for making radiographs, including restraint, record keeping and protective clothing
89
Q

How can radiation exposure be monitored?

A
  • Most commonly film badges or thermoluminescent dosimeters (TLDs)
  • Worn by all staff regularly involved with radiography
  • Regularly checked
90
Q

Describe PPE used in radiogaphy

A
  • Only protects against scattered radiation
  • Aprons and gloves to protect hands and arms (0.25mm lead for aprons, 0.35mm lead for gloves)
  • Also thyroid protectors available
  • Stored flat to prevent cracking of lead rubber
  • Regularly checked for cracks or other defects
91
Q

What are the potential sources of radiation that may affect staff/

A
  • Direct beam
  • Leakage from tube head
  • Scatter from patient
  • Some primary beam will pass through patient, plate and table top i.e. go all the way through to the floor (or foot)
92
Q

How can radiographic procedures be optimised?

A
  • Minimise risk to personnel
  • Follow Local Rules
  • Consider and prepare carefully for each procedure (e..g direction of primary beam, scatter)
  • Good positioning, centring, collimatin, labelling, avoid artefacts
  • Correct exposure
  • Good processing
  • Reduce need for repeats
  • Avoid exposure creep
93
Q

How can risk to the public/other staff from radiation be minimised?

A
  • Warning lights and signs
  • Written arrangements
  • Staff familiar with safety and procedures
  • Regular servicing of equipment
94
Q

What are the provisions for manual restraint of large animals for radiography?

A
  • Must be wearing adequate protective clothing
  • Stand as far outside of primary beam as possible
  • 1 person may hold head
  • Use self supporting boxes or cassette holder or long-handled cassetter holders if it is necessary to hold
  • Use chemical restraint where possible
95
Q

Outline the practical measures that can be used to limit access to radiation exposure in small animal practice

A
  • Mostly suing vertical primary beam
  • Always use good chemical restraint where possible
  • Appropriate physical restraint
  • Should not need to be in the same room for most small animal procedures
96
Q

In what circumstances is manual restraint for radiography permitted?

A
  • Animal is critically ill and cannot be sedated/anaesthetised
  • Radiography must be essential to teh case managemetn
97
Q

How can scattered radiation be controlled?

A
  • Reduce amount produced using adequate collimation, using lowest possible kV that will still produce a diagnostic image
  • Use grid in patients deeper than 10-15cm
  • reduce effect of scatter on personnel by increasing distance and using appropriate PPE
98
Q

What is the importance of the inverse square law with regards to radiation safety?

A
  • Intensity of x-ray is inversely proportional to the distance^2 from their source
  • So if double the distance from the source of x-rays, reduce intensity to a quarter
  • Therefore distance is a good way of reducing hazard
99
Q

What views are commonly taken for radiographs of the following joint scenarios in small animals?

a: caudal aspect of elbow
b: carpus fractures
c: hips dysplasia screening
d: tarsus OCD

A

a: flexed lateral view
b: oblique views
c: only ventrodorsal required
d: oblique views

100
Q

How is a decubitus lateral view performed?

A

Patient in lateral recumbency, x-ray film place perpendicular to the table at the patient’s spine, supported by snadbags. Machine head rotated to be parallel to the table,i.e. x-ray beams will be horizontal

101
Q

When might a decubitus lateral view of the abdomen be performed?

A

To look for free abdominal gas, as this will move to the top of the abdomen

102
Q

What are key challenges when acquiring a thoracic radiograph?

A
  • Accurate positioning to avoid axial rotation
  • Achieving adequate lung inflation
  • Avoiding movement blur
103
Q

Outline the advantages and disadvantages of a ventrodorsal thoracic radiograph

A
  • Disadvantages: heart rotates to one side and distorts shadow
  • Advantages: may produce better pulmonary detail, more sensitivity for the detection of small amounts of pleural fluid
104
Q

What are the advantages of right lateral thoracic radiographs?

A
  • Heart position more consistent
  • More lung between heart and chest wall
  • Diaphragm obstructs less of the lung field
105
Q

What are the advantages of dorsoventral thoracic radiographs?

A
  • Safer in dyspnoeic animals

- Heart lies in anatomically correct position

CPS (13 decks)

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