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AAA Companion Animal VMS4005 > STEEPLECHASE RADIOGRAPHY > Flashcards

STEEPLECHASE RADIOGRAPHY Flashcards

(201 cards)

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1
Q

Overexposure

A
  • Black
  • High mAs, high kV
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2
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Underexposure

A
  • Too white
  • Low mAs, low kV
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3
Q

Radiolucent

A
  • Black - radiation passes through
  • Gas = black, low atomic no. + specific gravity, does not absorb as many photons
  • Fat = lighter grey
  • Fluid = shades of grey
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4
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Radiopaque

A
  • White - inc absorption of radiation, less radiation passes through to detector
  • Bone - high atomic no. + specific gravity, absorbs more photons
  • Metal
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5
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Radiographic report

A
  • Description - signalment + Hx, area imaged, projections
  • Quality - exposure, positioning, technical faults
  • Dx - description of image, identify variation from normal, summary of findings
  • DDx - prioritise list - most sig, incidental findings
  • Recommendations - imaging, Sx, Dx, ongoing managmenet
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6
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Radiographic interpretation - what to comment on

A
  • P - positioning
  • C - centring
  • C - collimation
  • E - exposure
  • L - labelling
  • A - artefacts
  • Pink camels collect extra large apples
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7
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Positioning

A
  • Area of interest
  • Projections - e.g. lateral, R/L
  • Lying on back = VD
  • Sternal = DV
  • Thoracic distal limb - radius/ulna = CC, craniocaudal
  • Hindlimb = dorsal/plantar/palmar
  • Standard views
  • Standard pos
  • Standard exposure settings
  • Orthogonal view - 90 degree, prevent twisting/minimise geometric distortion
  • Magnification
  • Centring
  • SI loops v mobile + easily displaced
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14
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Centring

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  • Anatomical area of interest using bony landmarks
  • Allows close collimation to avoid scattering
  • Cross on light diaphragm when collimator light on
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15
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Collimation

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  • Reduce radiaiton dose, scatter + improves contrast + image quality
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16
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Comment on exposure

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18
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Underexposed

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20
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Labelling

A
  • L/R marker
  • Patient name + date
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21
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Lateral views

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  • Rostral part of animal to viewer’s left
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22
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Ventrodorsal/dorsoventral

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  • Rostral part of animal pointing up + left of animal to viewer’s right
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23
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Lateromedial/mediolateral extremities

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  • Proximal limb up
  • Cranial/dorsal limb to viewer’s left
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24
Q

Craniocaudal/caudodorsal extremities

A
  • Lateral aspect of limb to viewers left
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Artefacts
- Incorrect/no labelling - Poor positioning - Poor collimation - Movement blur - Fogging - Double exposure - Radiopaque artefacts on patient - mud, wet coat, syringe under patient
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Inc size
- Hypertrophy - Hyperplasia - Neoplasia - Torsion - Cystic change - Compare size to another structure/fixed landmark e.g. liver enlargement if extended costal arch, comparing kidney to lumbar vertebrae
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Dec size
- Atrophy - Hypoplasia - Congenital anomaly
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Localised/diffuse shape
- Neoplasia - Necrosis - Ulceration - Physiological enlargement e.g. blood in spleen, uterus preg, aerophagia in stomach - Pathological enlargement - neoplasia
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Inc no.
- Accessory ossification centre - Congenital anomaly
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Dec no.
- Congenital anomaly
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Inc opacity
- Calculi - Mineralisation - Fluid/ST in gas-filled structure - FB - Metallic opacity
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Dec opacity
- Abnormal gas - Osteopoenia (dec bone density)
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Dec margination
- Periosteal reaction - Protruding mass - Free abdominal fluid -> loss in serosal detail - Young + emaciated animals have poor serosal detail
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Positioning - This is a right lateral thorax of a skeletally mature dog - The animal is not positioned straight. The forelimbs are not parallel causing rotation of the spine and thorax which can also be seen by the ribs not being superimposed. The forelimbs should also be extended forwards to avoid superimposition of the soft tissue of the legs over the cranial thorax. Centring - The image is centred too far caudally resulting in the mid point of the thorax not being in the centre of the image. Collimation - The collimation should include the thoracic inlet and caudal rib, and both dorsal and ventral skin edges. In this image the collimation is too wide ventrally and cranially. Some of the last rib is missing. This will be due, in part, to the incorrect centring. Exposure - The exposure of the image is sufficient such that the image is of diagnostic quality. Labelling - The right marker is just present but not fully in the image so its position could be improved. No patient details are apparent but they may be stored on the file if this is a digital image. Artefacts - There is artefact from dirt on the coat ventrally. Geometric distortion is present due to the limbs not being kept parallel but this does not affect the interpretation of the image as such.
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Displacement of position
- Torsion - Ectopia - Hernia
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Shoulder
- Mediolateral + caudocranial
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Lateral thoracic
- 1y beam centred over mid thorax - 1y beam collimated to include: manubrium/thoracic inlet, last rib, dorsal + ventral skin edges
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Dorsoventral thoracic
- 1y beam centred over mid thorax - 1y beam collimated to include manubrium/thoracic inlet, last rib, lateral skin edges
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Craniocaudal elbow
- 1y beam centred midway between humeral condyles - 1y beam collimated to include: 1/3 way along radius/ulna distally, 1/3 way along humerus proximally + lateral skin edges
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Mediolateral elbow
- 1y beam centred over humeral condyle - 1y beam collimated to include: 1/3 of way along radius/ulna distally, 1/3 way along humerus proximally + tight to the lateral skin edges as possible w/o compromising the imagine
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Lateral abdominal
- 1y beam centred over mid abdomen/last rib - Centre midway between spine + ventral aspect of body - 1y beam collimated to include: entire diaphragm, pelvic outlet, dorsal + ventral skin edges
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Ventrodorsal abdominal
- 1y beam centred midline caudal to last rib - 1y beam collimated to include: entire diaphragm, pelvic outlet + lateral skin edges
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Mediolateral stifle
- 1y beam centred distal to femoral condyles - 1y beam collimated to include: distal 1/3 of femur + proximal 1/3 of tibia
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Ventrodorsal hip
- 1y beam centred on pubic symphysis/midline between hips - 1y beam collimated to include: lateral skin edges, cranially to iliac crests, caudally to mid femur
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Elbows
- Mediolateral (neutral, flexed, extended) - Craniocaudal
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Carpus
- Mediolateral (flexed + extended) - Dorsopalmer
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Distal limb (thoracic)
- Dorsopalmer - Mediolateral splayed digits - Oblique
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Hips
- Ventrodorsal + lateral pelvis
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Stifles
- Mediolateral - Caudocranial
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Hocks
- Mediolateral (flexed + extended) - Plantarodorsal
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Distal limb (pelvic)
- Plantarodorsal - Mediolateral splayed digits - Oblique
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Rules of thumb - limb imaging
- Two orthogonal projections at right angles - Include joint above + below Fx - Use contralateral limb for comparison - Include 1/3 long bone proximal + distal to joint
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Limb imaging exposure criteria
- Should be able to assess bone + ST - See trabecular detail in bones - Cortical bone = dense white - ST = grey tones - Underexposure = bone homogenous white
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Limb - approach to evaluation - Soft tissue
- Localisation - Change in tissue mass - Opacity - around bone
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Limb - approach to evaluation - bone
- Lesion description - Location within bone - Epiphysis, metaphysis, diaphysis - Periosteum, cortical bone, endosteum, trabecular bone, medullary cavity - Opacity - Margins - Joint involvement - ST involvement
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Limb - approach to evaluation - joints
- Alignment of bones - Character + distribution of bony lesion
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Soft tissue evaluation - change in tissue mass
- Diffuse inc - SC fluid, oedema, lymphoedema, cellulitis, neoplasia, emphysema (inc air) - Localised inc - abscess, cyst, haematoma, neoplasia, assess adjoining bony structures for neoplasia - Atrophy - disuse, neurogenic, myositis, weight loss
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Soft tissue evaluation - changes in opacity, inc in opacity (more white)
- Artefacts - dirt, foreign material - Calcification - calcinosis cutis (Cushing's/hypoadrenocorticism), calcinosis circumscripta, tendon mineralisation, metastatic (calcium phosphate) mineralisation - Ossification - extraskeletal osteosarcoma, myositis ossificans - Radiopaque FB
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Soft tissue evaluation - changes in opacity, dec in opacity (more black)
- Fat - lipoma - Gas - puncture, sinus, open Fx - Facial planes - radiolucent lines gas lines between
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- Inc ST opacity - Calcinosis circumscripta
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Describing lesions - bone
- Monostotic - lesion present in one bone, e.g. osteosarcoma - Polyostotic - lesion present in many bones, e.g. multiple myeloma - Focal lesion present in specific bone region e.g. metaphysis/diaphysis - Generalised - involving all bones, often a metabolic condition - Symmetrical - present on both sides of a bone e.g. metaphyseal osteopathy - Asymmetrical - present on one side only e.g. from premature closure of a growth plate due to trauma - Physis - only present in immature animals where growth plate has not closed, relevant for salter harris fracture classifications
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Bone lesion location
- Areas of each bone - periosteum, cortex, medullary cavity, physes - Proximal or distal? etc - planes
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New bone formation
- Response to injury/insult or neoplasia Internal - Inside medullary cavity - trabecula, endosteum - Reactive - inc thickness of normal trabeculae, organised homogenous appearance: panosteitis - Neoplastic - non-homogenous - osteosarcoma, chondrosarcoma Periosteal - External to bone - As result of injury/insult
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Panosteitis - painful inflam of outer surface or shaft of long bone
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Periosteal reactions
(In order of aggression) - Smooth/solid - Laminated - Sunburst - Codman's triangle - Amorphous
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Periosteal reaction - smooth
- Slow lifting of periosteum over period of time - New bone laid down below - Solid + uninterrupted change
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Periosteal reaction - laminated
- Slower process - More aggressive than smooth - Periosteum lifted in interrupted fashion resulting concentric laminated layers - onion skin - Layers of periosteum + cortex
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Periosteal reaction - sunburst
- Highly aggressive process - Lesion is growing rapidly that periosteum doesn't have time to lay down layer of new bone - Sharpey's fibres stretched out perpendicular to bone then ossify - Osteosarcomas
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Periosteal reaction - Codman's triangle
- Rapid process - Cortical destruction present - Edges of periosteum raised + ossify forming triangle w/ surface of bone - flap/angle against bone
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Periosteal reaction - amorphous
- Not technically periosteal reaction - Neoplastic new bone seen beyond destroyed periosteum - 'Cotton wool' like - Highly suggestive of osteosarcoma (almost always neoplastic)
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- Solid periosteal reaction
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Lamellated/laminated periosteal reaction
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Sunburst periosteal reaction
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Codman's periosteal reaction
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Types of bone loss
- Lysis, loss = radiolucent Order of aggression - - Focal - Geographic - least aggressive + slower growing lesions - single large radiolucent lesion w/ sclerotic rim + cortex destruction - Moth-eaten - multiple separate foci or lysis, more ill-defined + transitional zone between affected + non-affected bone - Permeative - most aggressive + rapidly growing lesions, numerous areas of lysis w/ poorly defined borders + wide + indistinct transition zone
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Inc bone opacity
- Real - new bone production - Artefactural - superimposition - of Fx = poor positioning
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Dec bone opacity
- Bone loss = radiolucent - Real = generalised of focal bone loss - Artefactual - superimposition gas, focal reduction of ST
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Osteopenia
- Generalised bone loss - imbalance between bone formation + resorption - Generalised = dietary, disuse, hormonal deficiency, congenital - E.g. Nutritional 2y hyperparathyroidism, Fx, endocrine, Cushing's, diabetes, pituitary dwarf, rubber jaw congenital disease - affects PO4^3- - Localised = pressure - from neoplasia, infection
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Osteoporosis
Bone atrophy
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Osteomalacia
- Reduction bone mass - Failure of mineralisation of newly formed bone
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Geographic lysis
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Permeative lysis
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Moth-eaten lysis
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Joint changes - what should be assessed
- Joint space - Joint margins - Subchondral bone - Loose bodies - Alignment of articular surfaces
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Causes of increased width of joint space
- Skeletal immunity - Synovial effusion - Joint laxity - Joint incongruity - Thickened cartilage - Destruction of subchondral bone
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- Inc width of joint space - Ligamentous tear to stifle
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There should be radiolucent fat pad, its absence suggests inflam
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Osteophyte
- Outgrowth of bone at margin of articular surface of synovial joint - E.g. New growth, osteoarthritis
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Enthesophyte
- Focal proliferation of new bone to form a spur at an attachment of ligament - E.g. Trauma
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Calcification
- Loose fragment of calcified tissues - E.g. Joint mice
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Osteophyte
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Subchondral bone abnormalities
Irregularities of the margin due to OCD, sepsis, or immune-mediated joint disease
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Defect in subchondral bone due to OCD
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R Lateral view of cat hock
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- ST - more radiopaque, inc opacity, inc mass/swelling - Bone - mid-diaphyseal transverse/oblique Fx, slightly commuted (more than two bits) - Oblique Fx of fibula - Lysis of bone in prox epiphysis/metaphysis region, loss of opacity + moth-eaten appearance, poor margins in transition zone = patho, bone neoplasia, tibia not got much chance of Fx
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- ST hard to evaluate - Moth-eaten bone, a lot of lysis but clear transition zone in proximal part of bone, cotton wool appearance on periosteum, neoplastic process, no change across joint space
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Elbow - ST - slight swelling, not marked - Bone - enthesophytes around edges of bone - calcification in ST - within tendon/ligament, osteophytes around margins of bone = irregular border of bones - Joint - margin/space = irregularity, one side wider than other, asymmetry, narrowing of joint space at radial head - Osteoarthritic changes (often due to elbow dysplasia), early arthritic changes
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- ST - not much on foot, slightly radiopaque, digit 5, thickening around toe, inc ST mass - Bones - fabellas present on top of toes, margins abnormal - oesteophytes growing off margins (articular types) - Joints - space - narrower compared to other toes - Old Collie w/ bad arthritis in feet
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Head radiography indications
- Deformity, swelling, or discharging sinus - Trauma - skull Fx - Ear disease - tympanic bullae - Exophthalmos (bulging eyes) or Horner's syndrome (less sensitive - US/CT) - Pain in head area - Problems w/ jaw mobility/teeth - dislocations, diff opacities - Nasal or nasopharyngeal disease - Dental disease
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Dolichocephalic - long-nosed skull
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Lesion orientated view of swelling
Oblique lateral views - avoid superimposition
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Nasal cavities
Dorsoventral intra-oral (DVIO) - x-ray plate in mouth on top of tongue to see through nose, septal deviation
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Ramus of mandible, mandibular teeth
Ventrodorsal intra-oral - plate in mouth, x-ray through mandible
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Nasal cavities more caudally + laterally
Ventral 20° rostral-dorsocaudal oblique
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Tympanic bullae (dog)
Rostrocaudal open mouth
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Tympanic bullae (cat)
Rostral 10° ventral-caudodorsal oblqiue
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Skyline calvarium + frontal sinus
Rostrocaudal + caudodorsal closed mouth
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Head abnormal findings
- Fx - cranium, maxillae, mandible, zygomatic arch - Congenital/developmental conditions - Neoplasia - cranium, maxillae, mandible - Craniomandibular osteotomy (lion jaw in Westies) - periosteal reaction on mandibles, tympanic bullae, fluffy - Ear disease - changes in bullae
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Hydrocephalus - no bony markings on cranium
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Dental indications
- Dental trauma - chewing - Jaw Fx - Anodontia (absence of teeth) - Retained deciduous dentition (below gum/crypt) - Periodontal disease - abscess? - Endodontic disease - Extraction of teeth - Malocclusions - Nasal discharge - Swellings, cysts, neoplasms
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Dental radio - bisecting angle technique (lateral)
- X-ray beam = perpendicular to bisecting angle - creates shadows of teeth
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Incisors
- Bisecting angle - Dog in sternal - maxilla radiographed; or dorsal - mandible radiographed - Sensor sits in mouth w/ incisor teeth towards edge
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Maxillary canine teeth
- Lateral view + bisecting angle from rostral direction, plate for parallel does not fit as hard palate in the way - Sternal - Sensor placed flat on plate w/ rostral edge level w/ canine tooth - X-ray beam directed from ipsilateral side to 'cast the shadow' of the canine tooth onto the sensor
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Mandibular canine teeth
- Lateral/occlusal view - bisecting angle - Dorsal recum - Sensor placed on premolar teeth, w/ rostral edge of sensor level w/ canine teeth (smaller dogs - sensor can rest on tip of cusp of canine teeth) - X-ray directed from lateral aspect + w/ maxillary canine tooth
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Maxillary canine fourth premolar (upper carnassials/108, 208)
- Bisecting angle - Sternal - Sensor resting on plate + 4th premolar tooth (inside edge resting on palate, outside edge resting on main cusp of 4th premolar tooth) - X-ray beam directed towards same side as tooth imaged
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Parallel dental technqiue
- For caudal mandibular premolars + molars - Long axis of tooth + sensor are parallel + x-ray beam is at 90 degrees to sensor + long axis of tooth
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Mandibular first molar
- Parallel - Sensor placed into back of mouth w/ cheek teeth parallel - X-ray beam directed parallel to sensor
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- Tooth elongation - x-ray beam directed at 90 degrees to long axis of tooth - Move tube head more medially
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- Tooth shortening - x-ray beam directed at 90 degrees to film - To make roots longer, move tube head more laterally
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Dental radio interpretation
- Enamel - how radiopaque tooth looks on crown - Dentine - radiopaque - Pulp cavity - radiolucent - Alveolar bone - bone surrounding tooth - Lamina dura - radiopaue - Periodontal ligament space - radiolucent - Mandibular canal - Alveolar bone height should extend to just below enamel/cementum junction
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- Feline odontoclastic resorptive lesions (FORL) - Red, raised granulation or premolar, probe = painful -> bleed of crown
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Periodontal disease - periapical abscess, loss of bone
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Neck + spine radio indications
- Mono-, para- + quadriplegia - Paresis or paraparesis - Ataxia - bilateral may have bilateral cruciate disease - Spinal pain - Stiffness - Suspected vertebral deformities - Sinus tracts in lumbar region - FB
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Neck + spine - lateral
- Spine parallel to table top - Foam wedge - under neck: between limbs, under lumbar spine; cervical spine: under nose - Forelimbs - servical spine drawn caudally - Should have super imposition of: wing of atlas, transverse processes of C6, equal in size - Rib origins - Lumbar transverse processes - Wings of ilia
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Neck + spine - ventrodorsal
- Dorsal recum - Support w/ radiolucent trough - Foam wedges to prevent rotation - Should have oval central opacities of spinous processes, equally-sized transverse processes
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Centring - upper cervical
C2 - C3
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Centring - lower cervical
C5 - C6
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Centring - mid-thoracic
T8
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Centring - thoracolumbar junction
T13 - L1
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Centring - mid-lumbar
L4 - L5
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Centring - lumbosacral
L7 - S1
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Spinal radiograph interpretation
- Vertebral alignment - Length, shape, opacity, vertebral bodies - should be square - Contour + opacity of vertebral end plates - where vertebrae meet at disc, changes in opacity e.g. disc spondylosis - Intervertbral disc space width + opacity - Articular process joints - Paravertebral ST
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(MRI)
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Abdo radiography indications
- Abdo distension, enlargement - Investigation of palpable masses, enlargement - Weight loss - wellbeing screening - Abdo pain - Screening for neoplasia - staging, may be 2y in abdo - Screening following trauma - look for H+/fluid - GI signs - Urinary signs - Repro tract examination
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Abdo exposure
- Low kV + high mAs -> max contrast due to ST organs, fat + mesentery
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Abdo positioning
- Main orthogonal views = ventrodorsal (in sternal), organs spread out + Right lateral - +/- Left lateral (Dorsoventral, decubitus lateral)
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Stomach
- Cranial abdo, caudal to liver - Opacity depends on content e.g. food, gas, fluid - Gas distribution - depends on position
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GDV - looks like smurf!!!
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SI - ileus
- Abnormal inc in diameter = dilation - > 1.6 x height lumbar vertebrae L5 - Dilated loops containing fluid, gas or mixture - Assess no. dilated loops + position
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SI - obstructive (mechanical) ileus
- FB - dilation of SI proximal -> nothing gets past - Neoplasia - Intussusception - teloscoping, young puppies - worm burden
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SI - functional (paralytic) ileus
- Hypokalaemia - Peritonitis - Inflammation (enteritis)
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LI
- Relatively consistent in appearance - Filled various amounts - heterogenous faecal material
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LI - constipation
- LI dilation w/ opaque faecal material - Megacolon - esp cats - Bone ingestion - dogs, radiopacities
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LI - ventral displacement
Enlargement of kidney, sub-lumbar LN, retroperitoneal space
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LI - dorsal displacement
Enlarged prostate, uterus (pyometra), bladder
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GIT - positive contrast studies
- After plain radiography - More opaque than ST - Barium sulphate - PO/per rectum - Good at coating mucosa - Contraindication if aspiration risk e.g. megaoesophagus
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Generalised hepatomegaly
- Caudal displacement of pylorus - Extension beyond costal margin (gastric access) - Non-specific finding - US-guided FNA needed for Dx
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Liver neoplasia
- Generalised hepatomegaly - Cranial abdo mass - Haemoabdomen
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Spleen neoplasia
- Variable sized mid abdominal ST mass - Haemoabdomen - haemangioma/haemangiosarcoma, haematoma
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Portosystemic shunt
- Small liver = microhepatica - Abdo US + doppler required
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Urinary tract organs
(US better) - Kidneys - size, shape, opacity + position, no information on func, length 2.5 - 3.5 x L2 (dog) / 2.4 - 3.0 x L2 (cat) - VD - Ureters + urethra - need contrast study - Bladder - location, size, shape, no info on luminal surface bladder wall - Prostate (dog) - size + location, height not more than 70% height pelvic brim
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Sludgy bladder - rabbits, too much Ca2+ in diet
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Urinary tract - contrast studies
- Double contrast cystogram - Retrograde urethrogram - Retrograde vaginourethrogram - Intravenous urography - Positive contrast = water-soluble iodinated contrast material = conray or omnipaque - Negative contrast = air (pneumocystogram) or CO2 - Enema essential - Check renal parametets - Admin IVFT - GA, don't withhold water
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Urinary tract contrast studies - views
- Plain lateral + VD - Lateral + VD immediately post-injection and at 5 min + 10 min - Lateral at 15 min post injection
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Urinary tract - contrast study indications
- Internal architecture kidneys = cystogram - Delineates ureters - where enter bladder - Ectopic ureter Dx - cystography too sensitive
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Incisor malocclusion
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Rabbit
- No obvious spinal abnormalities or arthritic changes seen (but VD view of caudal spine, hips and hind legs under sedation would be required to confirm this) - No uroliths visible - Intestines diffusely distended with gas but no gastric dilation/bloat - Ileus - gut stasis
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Rabbit
- Radiopaque substance in the bladder, seems to be a ‘sludgy bladder’ because the mineral has settled in the ventral aspect of the bladder and has no defined circular outline to suggest a urolith. - No uroliths seen in kidneys/ureter/urethra/bladder
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Rabbit
- Bronchial and alveolar infiltrates bilaterally in the dependent portions of the lungs. - Caudal lung lobes appear hyperinflated with flattening of the diaphragm - Heart and pulmonary vasculature are not well identified. - Right 8th and 9th ribs are fractured - Indicate severe pneumonia.
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Rabbit
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Rabbit
Normal teeth - molars top + bottom, jagged points, cheese grater surface due to all grass + hay consuming
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Rabbit
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AAA Companion Animal VMS4005 (17 decks)

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