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Principles of Radiology

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Title: Principles of Radiology


1
Principles of Radiology
  • Daniel Podd RPA-C

2
Physics of Radiology
  • X-Rays produced by electron beam hitting tungsten
    film target
  • Electrons strike film, metallic silver is
    precipitated if no obstruction to beam, resulting
    in bright film
  • Obstruction in path of beam prevents silver
    precipitation film remains dark
  • The negative of this film is known as the Plain
    X-Ray, or radiograph

3
Positive Negative (Developed)
Radiograph, Plain Film
4
Radiodensity as a Function of Thickness
5
Radiodensity as a Function of Composition with
Thickness Kept Constant
6
X-Ray
A-D Radiolucent or Radioopaque?
Why?
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9
AP CHEST Patient Position
10
AP CHEST
11
PA CHEST Patient Position
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L Lung R Rib T Trachea  AK Aortic knob A
Ascending aorta H Heart   V Vertebra
P Pulmonary artery S Spleen
14
Lateral
15
Bullet PA only ?
16
Bullet PA Lateral
17
PA Chest
Lordotic View
18
Fluoroscopy
  • Mechanism Continuous below patient, amp- lified
    by intensifier above patient broadcast on
    high-resolution television screen
  • Provides live animation
  • Imaging reversed vs xray
  • Uses Barium swallow to

X-ray beams from
evaluate esophagus,
  • small and large intestines, vessel catheter
    guidance

19
Fluoroscopy
Spot Film Single X-ray during procedure. Film
developed into negative
20
Angiography
  • Mechanism Uses X-rays and intravascular
    injection of iodinated contrast to evaluate
    arterial (arteriogram) and venous (venogram)
  • systems
  • Vasoocclusive
  • disease
  • Most approaches
  • via femoral artery
  • or vein

21
Computerized Axial Tomography
  • Cross-sectional slice radiographs of the body
    using thin beam of X-rays through desired axial
    plane
  • Slices up to 1.0 mm that represent density
    values no superimposed images
  • Viewed as if facing patient and looking up
    through feet
  • Density Less Dense Air, Fat (black)
  • More Dense Bone (white)

22
CT Scan
23
CT Scan Angiography
  • 3DCT, 3-Dimensional CT scan
  • Injection of IV contrast to enhance vascular
    system
  • Useful for aortic aneurysms, coronary heart
    disease, carotid vascular occlusive disease

24
CT Scan Angiography
25
Ultrasound
  • Mechanism High-frequency sound waves beamed
    directed into body, onto organs and their
    interfaces transducer receives and interprets
    reflection of these beams from organs
  • Acoustic Impedance beam absorption by tissues,
    based on density and velocity of sound through
    different adjoining tissue types

26
Ultrasound
  • Image (echo) produced when different neighboring
    tissues reflect different acoustic impedances
  • Solid organs, fat, stones Echogenic (white)
  • Fluid cysts Anechoic (black)

27
Ultrasound
28
Ultrasound
  • Advantages
  • No ionizing radiation
  • Applicable to any plane
  • Cost-effective
  • Portable
  • Real-time imaging

Disadvantages 1. Time consuming 2. Poorer quality
29
Magnetic Resonance Imaging (MRI)
  • Mechanism Patient placed in magnet tunnel
    radio waves passed through body in pulses. Pulses
    returned from tissues, transformed into 2D image
    based on relaxing times T1 T2
  • T1
  • T2

High Signal (brightness) Low
Signal
fat, medullary bone blood (gray), solid mass, cysts, air, compact bone
tumors, solid masses, CSF, cysts compact bone, blood, fat, air
30
MRI
  • Advantages vs CT
  • Multiplanar scanning
  • Better soft-tissue differentiation
  • 3. Contrast-free 3DMR
  • Contraindications
  • Metals, clips, pacemakers

31
MRI
T1
T2
32
Normal CXR
33
Normal CXR
34
Enlarged Hila
35
Aortic Knob
Hilar Mass (Left)
36
Right vs Left Pulmonary Artery

37
  • Kerley B-Lines
  • Fine horizontal opacified
    lines representing pulmonary edema
  • Seen in CHF, pulmonary fibrosis, heavy metal
    fibrosis, malignancy

38
Blunted Costophrenic Angle
39
Lung Mass Cavitation
40
Lung Mass Solid Tissue
41
Air Space (Alveolar) Disease
42
Interstitial Disease
43
Alveolar or Interstitial?
44
Alveolar or Interstitial?
45
Alveolar or Interstitial?
46
Lobar Consolidation Right
  • Think anatomically
  • 3 Lobes
  • RLL located Lateral to heart, but anterior to
    diaphragm
  • Obliteration of right CoPhS
  • Right heart border intact
  • RUL and RML located
  • Anterior to heart
  • Obliteration of
  • mediastinum and cardiac
  • borders
  • Right CoPhS intact

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50
Lobar Consolidation Left
  • LUL lies anterior to heart and superior to
    diaphragm (and LLL)
  • Obliteration of left heart border only
  • Left hemidiaphragm intact
  • LLL located lateral to heart and anterior to
    diaphragm
  • Obliteration of left hemidiaphragm
  • Left heart border intact

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53
Where Is This Consolidation?
54
Diaphragm
Gastric Bubble
55
Diaphragm Expiration vs Inspiration
56
Pleura
  • Anatomically, the visceral and parietal pleura
    are separated by a potential space, the pleural
    space
  • Fluid in this space is known as a Pleural
    Effusion
  • Effusions may be large or small, but settle to
    base of lung due to gravity
  • Completely obscures aerated lung and
    heart/mediastinum/diaphragm borders

57
Pleural Effusion Large
58
Pleural Effusion Small
59
Pleural Effusion Small (special case)
60
Pleural Effusion Small (special case)
61
Pneumothorax
  • Introduction of air into the normal vacuum of
    pleural space
  • Radiographic findings
  • 1. Hyperlucent versus aerated lung 2. Passive
    atelectasis of ipsilateral
    lung
  • 3. Depression of ipsilateral
    hemidiaphragm
  • 4. Mediastinal shift

62
Pneumothorax
  • Optimal Radiographic Images
  • Expiration film
  • 2. Lateral decubitus film

63
Pneumothorax
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65
Subtle Pneumothorax
66
Pulmonary Embolism
  • Lung vessel embolus
  • Radiologic findings
  • 1. Diminished lung volume
  • Elevated ipsilateral
    hemidiaphragm
  • Linear/patchy ipsilateral atelectasis
  • 2. Completely Normal ! (m/c)
  • CXR to rule out other etiologies

67
Pulmonary Embolism
68
Pulmonary Embolism
  • With Infarction
  • 1. Hamptons Hump

69
Pulmonary Embolism
Further Diagnostics
  • Perfusion Test (Q)
  • Technetium-99
  • Ventilation Test (V)
  • Xenon gas

Perfusion/Ventilation mismatch, V/Q Mismatch
70
Pulmonary Embolism
  • V/Q Scan Interpretation
  • Normal Perfusion scan Rules out PE
  • Negative/Low Probability scan (slight perfusion
    abnormality or V/Q matching) Non-embolic
    pulmonary abnormalities
  • Positive/High Probability V/Q mismatch
  • Intermediate/Indeterminate Low High
  • Pulmonary Angiogram indicated for 3, 4, or 2 with
    strong clinical evidence

71
Pulmonary Angiogram
  • Gold Standard

72
Helical (Spiral) CT Scan
  • Indicated for suspected PE with abnormal CXR
  • CT venogram Adding IV contrast for concurrent
    deep leg vein scan

73
References
  • http//www.vh.org/adult/provider/radiology/icmrad/
    chest/parts/Righthilum.html
  • http//www.meddean.luc.edu/lumen/meded/medicine/pu
    lmonar/cxr/atlas/cxratlas_f.htm
  • http//www.meddean.luc.edu/lumen/meded/medicine/pu
    lmonar/cxr/atlas/hilar.htm
  • http//uwcme.org/site/courses/legacy/threehourtour
    /edema.php
  • http//www.meddean.luc.edu/lumen/meded/medicine/pu
    lmonar/cxr/atlas/apwindow1.htm
  • http//info.med.yale.edu/casebook/intmed/manditi/t
    est_results.html
  • http//www.meddean.luc.edu/lumen/meded/medicine/pu
    lmonar/cxr/atlas/normallabeled.htm
  • http//www.premedonline.com/Personal_Page/rad.html
  • http//sfghed.ucsf.edu/ClinicImages/chest_and_pelv
    is_films.htm
  • http//www.virtual.epm.br/material/tis/curr-med/me
    d3/2003/ddi/matdid/cap2.htm

74
References
  • http//www.virtual.epm.br/material/tis/curr-med/me
    d3/2003/ddi/matdid/cap1.htm
  • http//www.fhsu.edu/nursing/cxr/CostoPhrAngCopy.ht
    m
  • http//www.aic.cuhk.edu.hk/web8/0122_CONSOLIDATION
    _LATERAL_SEGMENT_RML.jpg
  • http//www.med.wayne.edu/diagRadiology/TF/Chest/CH
    04.html
  • http//acbrown.com/lung/Lectures/RsVntl/RsVntlMscl
    Dphr.htm
  • http//www.nyp.org/masc/images/nl3_ph11.jpg
  • http//www.lumen.luc.edu/lumen/MedEd/medicine/pulm
    onar/images/effusion.jpg
  • http//brighamrad.harvard.edu/Cases/bwh/hcache/116
    /full.html
  • http//www.radiology.co.uk/srs-x/cases/094/a.htm

75
References
  • http//brighamrad.harvard.edu/Cases/bwh/images/84/
    R54A2.GIF
  • http//uwcme.org/site/courses/legacy/threehourtour
    /images/PTXPA.jpg
  • http//www.med.wayne.edu/diagRadiology/TF/Chest/CH
    08.html
  • http//www.nature.com/ncpcardio/journal/v2/n2/thum
    bs/ncpcardio0118-F2.jpg
  • http//www.vh.org/adult/provider/radiology/icmrad/
    nuclear/parts/HiProb.html
  • http//www.rochestermedicalcenter.com/images/a015.
    jpg
  • http//www.engineering.uiowa.edu/bme185/angiogram
    .gif
  • http//www.vh.org/adult/provider/radiology/Electri
    cPE/RadImages/03.RT-Angio.gif
  • http//www.usask.ca/medicine/imaging/Clinical/GF.s
    html
  • http//health.allrefer.com/pictures-images/pancrea
    tic-cystic-adenoma-ct-scan.html
  • http//www.mia.net.au/perrett/info_general/ct_angi
    o/Image2.jpg
  • http//www.terarecon.com/gallery/images/us_7_galls
    tones.jpg
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