Term
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Definition
| The puncture of a vein as part of a medical procedure, typically to withdraw a blood sample or for an intravenous injection |
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Term
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Definition
1. Blood extraction for analysis
2. For IV therapy
2. FOR INTRAVENOUS THERAPY |
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Term
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Definition
1. Vein has deoxygenated blood
2. Easier to access vein
3. Less damage if punctured
4. Minimal nerve damage
5. Thinner walls
6. Veins have valves |
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Term
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Definition
1. Superficial Veins
2. Deep Veins
3. Systemic Veins
4. Pulmonary Veins |
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Term
| Vein structure, from outer to inner |
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Definition
1. Tunica adventia
2. Tunica media
3. Tunica intima |
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Term
| Tips for selecting a vein for puncture |
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Definition
1. Avoid lower extremity
2. Avoid joints
3. Avoid small veins
4. Avoid non dominant extremity |
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Term
| Tips for selecting a vein for puncture (cont.) |
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Definition
1. Avoid the side of mastectomy
2. Avoid scarred areas
3. Avoid blood transfusion side
4. Avoid dialysis side |
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Term
| Main upper extremity veins |
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Definition
1. Mediancubital vein
2. Cephalic vein
3. Brachialic vein
4. Metacarpal vein |
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Term
| Common access of upper extremity |
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Definition
1. Medial cubital vein
2. Easy to access
3. Disadvantage: Near elbow joint
4. Be careful if forearm has to bend (CT) |
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Term
| When is the external jugular vein used for puncture? |
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Definition
When hands/feet are problematic
Poor circulation patients |
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Term
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Definition
1. Keep all the supplies in hand
2. Tourniquet
3. Tapes
4. Cotton Balls
5. Gloves
6. IV Catheters
7. Alcohol Preps |
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Term
| Problems to expect with venipuncture |
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Definition
1. Dehydration/intravascular depletion
2. Chronic illness with venous scarring from frequent IV access
3. IV drug use with venous scarring
4. Obesity
5. Significant edema
6. Tortuous, fragile vessels due to advanced age
7. Thin vessel walls due to age, steroid use, certain disease conditions |
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Term
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Definition
1. Select the site
2. Apply tourniquet
3. Cleanse site with alcohol wipe
4. Insert the needle
5. Bevel side up
6. Insert the needle in a shallow angle – 15°-30° (You will see blood in the tube)
7. Release the tourniquet
8. Apply a tape over the butterfly wings
9. Leave the cap on at the other side of the tubing
10. As blood travels to the end of the tubing attach the tube to a syringe of any
other device |
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Term
| How many inches should the tourniquet be above the puncture site? |
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Definition
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Term
| Common venipuncture problems |
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Definition
1. Extravasation
2. Poor needle/vein contact
3. Contrast seeping under skin (Painful, bluish color) |
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Term
| While rare, what could happen while taking a venipuncture? |
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Definition
Hitting an artery
You will feel a pulse
Arteries are interior
Too much blood is coming out |
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Term
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Definition
*Remove tape
*Pull needle without applying pressure
*Immediately apply pressure with dry gauze
*Elevate arm
*Check site after one minute
*Apply sterile dressing
*DOCUMENT EVERYTHING* |
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Term
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Definition
Disposal of needles and sharps
*Must be in rigid container
*Must be in a Red container marked biohazard
*Should not be bent or cut after use |
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Term
| What should you never do with a used needle? |
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Definition
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Term
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Definition
| Radiographic image of a deep vein after injecting contrast |
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Term
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Definition
1. Leg Pain
2. Leg Numbness
3. Arm Pain
4. Numbness in fingers/toes
5. History of poor circulation
6. Varicose Vein |
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Term
| Venograms are often conducted on? |
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Definition
Deep veins
Mostly lower leg, ankle to pelvis |
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Term
| Deep veins of the lower leg? |
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Definition
1. Anterior tibial
2. Posterior tibial
3. Popliteal
4. Femoral
5. External Iliac
6. Common Iliac
7. Inferior Vena Cava |
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Term
| Superficial veins of the lower leg? |
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Definition
Small Saphenous
*Off popliteal
Great Saphenous
*Off femoral |
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Term
| Why is the great saphenous vein important? |
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Definition
| 1. Longest superficial vein 2. Brings de-oxygenated blood from ankle and lower leg to the femoral vein 3. Has one valve 4. If it is not functioning well, blood flows back into smaller veins (varicose) |
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Term
| Indications for Venography? |
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Definition
Obstruction--Deep Vein Thrombosis (DVT)
*Pain, swelling and discoloration
Varicose Veins
Evaluation of Great Saphenous V. for graft
Deep Leg Pain
Trauma to evaluate vessel damage |
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Term
| Contraindications to venography |
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Definition
*Sensitivity to Contrast
*Advanced Hepatic Failure
*Renal Failure
*Known Phlebitis
*Excessive Swelling
*Diuretics
*Ace bandages
*Elevation of leg |
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Term
| How many cc's of media are used for extremities |
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Definition
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Term
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Definition
1. Patient lying down
2. Unaffected leg press on a weight
3. Dorsal pedi veins accessed
4. Contrast injected |
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Term
| Fluoro images of venograms are taken by who? |
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Definition
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Term
| Post venogram procedural steps |
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Definition
Flush veins with remaining IV fluids to remove contrast
Remove needle
Hold pressure
Apply bandage
Observe for bleeding and contrast reaction |
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Term
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Definition
Obstruction
*thrombosis, phlebitis or tumor
Phlebitis
Vein Varicosities
Congenital Abnormalities
Deep Vein Thrombosis
*can send emboli to Lungs |
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Term
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Definition
| Trauma patient who develops thrombosis in the upper extremity |
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Term
| Central venogram procedure |
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Definition
Anticubital or Axillary or Subclavicular vein accessed
Contrast injected
AP/LAT pictures taken |
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Term
| The superior vena cava will close due to? |
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Definition
Superior vena cava syndrome
or
Cancer/Tumors |
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Term
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Definition
Femoral vein approached
Rules out thrombosis of the IVC
Picture taken to see IVC from femoral vein to right atrium
Patient will have dull abdominal pain
(F) May have cysts in the ovaries/uterus |
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Term
| Selective venograms (Renal, Hepatic) |
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Definition
Femoral vein approach
Contrast injected
Rules out thrombosis |
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Term
| Advanced renogram procedures include |
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Definition
1. CT
2. MRI
3. US - DOPPLER |
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Term
| Most common type of contrast media? |
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Definition
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Term
| Ionic contrast reaction steps |
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Definition
3 atoms of iodine (2 side elements)
Cation (Salt)
*dissolves easily in blood
Anion = - charge
When in blood:
*Salt separates, forms 2 ions
*Increases osmolality
*Disturbes balance, so reaction occurs |
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Term
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Definition
BUN: 7-20mg/100ml
Creatinine: 0.6-1.2 mg/dl |
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Term
| Types of reactions to contrast media |
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Definition
1. Vasomotor
2. Anaphylactic
3. Vasovagal
4. Acute Renal Failure |
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Term
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Definition
Mild
Not Dangerous
Anxiety
Nausea
Mild Hives
Lightheadedness |
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Term
| What to do: Vasomotor reaction |
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Definition
STOP injecting
Inform doctor
Cold compress on forehead and neck
Calm the patient |
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Term
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Definition
Moderate to severe hives (urticaria)
Tachycardia
Laryngospasm (swelling)
Bronchospasm
Swelling of blood vessels (angiodema) |
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Term
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Definition
Throat closes
Pt. cannot breathe
Severe hives, itching
Cardiac arrest
Cyanosis
Give IV, 02, and call MD right meow |
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Term
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Definition
Hypotension
Bradycardia
No pulse
CALL CODE DUMBASS |
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Term
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Definition
| Used for facial edema & Bronchospasm |
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Term
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Definition
| Used for hypotension & bradycardia |
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Term
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Definition
| Acute pain & hypertension |
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Term
| Catheterization definition |
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Definition
| Inserting a tube into the body |
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Term
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Definition
*Can be left in place while radiographs are being done/ can be left for longer period
*Risk of extravasations is minimal
*Patient can be positioned with less discomfort as opposed to needles
*Amount of contrast agent delivered is reduced |
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Term
| When are urinary catheters used? |
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Definition
*Prior to surgery
*Infection
*Obstruction
*Narrowing of Urethra
*Bladder stones, Enlarged prostate, Blood clots, strictures |
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Term
| Foley catheter characteristics? |
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Definition
Two sizes: 5cc and 30cc
One end has a lumen for the urine to drip down
The other end can be connected to a bag for collection |
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Term
| Drainage Bag characteristics |
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Definition
Leg bag - Attached to the leg used in the day time
Hanging bag - Bigger and used in the night time
Bag HAS to be below the kidneys to prevent backflow |
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Term
| Foley catheter procedure steps |
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Definition
1. Sterile technique used
2. Place cleansed
3. Antiseptic lotion applied
4. Surgical drape placed
5. Local anesthesia given
6. Catheter is inserted
7. Balloon is inflated if needed |
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Term
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Definition
1. Balloon breaks
2. Balloon does not properly inflate
3. Urine stops flowing into the bag |
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Term
| Longterm effects of foley catheter useage |
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Definition
1. Urinary tract breakdown
2. Skin breaks down
3. Sepsis
4. Bladder cancer |
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Term
| Cardiac catheterization locations |
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Definition
1. Brachial artery
2. Axillary artery
3. Femoral artery |
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Term
| Methods of catheter measurement? |
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Definition
1. Inches
2. Millimeters
3. French Number |
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Term
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Definition
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Term
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Definition
1. Straight
2. Cobra
3. Pigtail
4. Tennis |
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Term
| The distal end of a catheter can be... |
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Definition
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Term
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Definition
1. Most widely used
2. Earlier techniques led to complications
3. Invented by a Swedish Radiologist named Seldinger
4. It is used to insert a catheter into a blood vessel or a hollow organ.
5. Used for Angiogram and chest drainage |
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Term
| Supplies needed for Seldinger technique? |
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Definition
1. Needle
2. Guide wire
3. Catheter
4. Alcohol wipes
5. Local anesthesia to numb the side
6. Betadine to clean the site |
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Term
| Seldinger guide wire size depends on? |
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Definition
Needle size
Lumen size of the catheter
Blood vessel size
Most are stainless steel |
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Term
| Seldinger stainless steel comes in 2 types |
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Definition
1. Solid stainless steel
2. Thin stainless steel with more stainless steel wrapped around |
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Term
| The 2nd type of stainless steel is also different in that |
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Definition
| The tip of the guide wire will have a coating of heparin or Teflon to reduce friction and damage to blood vessels |
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Term
| Seldinger guide wire length? |
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Definition
30-200cm
30cm used for direct vascular puncture
100cm-150cm for selective angiogram like renal or hepatic angiogram |
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Term
| Why is guide/needle size important? |
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Definition
Guide wire has to be big enough for the needle but small enough for the vessel
*Backflow of blood is possible if not followed |
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Term
| Seldinger technique steps |
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Definition
1. Clean and drape site
2. Local anesthetic
3. Needle puncture on both walls of vessel
4. Withdraw needle slowly until backflow
5. Insert guide wire
6. Remove needle
7. Insert catheter over the guide wire
8. Remove guide wire |
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Term
| What is a modified Seldinger technique |
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Definition
| Puncture only at the anterior wall of a blood vessel |
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Term
| What are the two other methods of catheterization? |
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Definition
1. Cutdown
*Minor surgery to isolate vessel
*Incision to skin, tissue separated, catheter inserted, stitch to secure
2. Translumbar (when peripheral artery not available)
*Patient prone
*Needle puncture at T-12 or L-2
*Needle into lumen of aorta |
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Term
| Complications of Catheterization? |
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Definition
At the site
*Bleeding
*Hematoma
*Thrombus
*Infection
From catheter & guidewire manipulation
*Embolization
*Dissection
*Impaction or breakage
Reaction to contast media |
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Term
| Post-catheterization procedural care |
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Definition
Pressure at catheter site for 5-45 minutes
Bed rest and monitoring for 12 hours (12-24 for translumbar)
Check:
Peripheral pulses
Limb color
Vital signs (4X 1st hour, 2x 2nd hour)
Urine output
Monitor sedation recovery
Monitor for allergic reactions |
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Term
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Definition
A device inserted under the skin to deliver medicines
A catheter connected from the device to a vein |
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Term
| Where is a port-o-cath inserted? |
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Definition
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Term
| What are benefits of port-o-caths? |
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Definition
1. Deliver chemotherapy
2. Deliever long-term antibiotics
3. Withdraw blood for tests
4. Deliver coagulation factors for hemophilia patients
5. Deliver radiopaque contrast for CT exams |
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Term
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Definition
1. Four chambers
2. Valves
3. Septums
4. Blood vessels |
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Term
| What does the septum of the heart do? |
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Definition
| Divides the heart into left/right sides |
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Term
| The right side of the heart has __________ blood |
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Definition
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Term
| The left side of the heart has ___________ blood |
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Definition
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Term
| Each side of the heart is divided into 2? |
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Definition
| Chambers (Atrium and Ventricle) |
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Term
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Definition
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Term
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Definition
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Term
| The four valves of the heart are? |
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Definition
L/R Atrioventricular
Aortic and Pulmonary Semilunar |
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Term
| Layers of the heart (outer-inner) |
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Definition
Pericardium
Myocardium
Endocardium |
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Term
| Electrical conduction of the heart |
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Definition
1. A-V Node
2. S-A Node
3. Bundle of HIS
4. Purkinje Fibers |
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Term
| A-V node characteristics? |
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Definition
Regulates heart rate
Located between atrium and ventricle |
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Term
| Parts of heart involved in circulation |
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Definition
1. SVC/IVC
2. Right atrium
3. Tricuspid Valve
4. Right ventricle - Pulmonary Semilunar valve
5. Pulmonary Trunk
6. Pulmonary Vein
7. Left Atrium
8. Bicuspid Valve
9. Left Ventricle - Aortic semilunar valve
10. Aorta |
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Term
| Purpose of the foramen ovale (heart)? |
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Definition
| Allows blood to pass through the right to the left atrium (closes at birth) |
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Term
| Oxygen-rich blood from the lungs enters the __ atrium through the pulmonary vein. The blood is then pumped into the ___ ventricle chamber of the heart through the mitral valve. From there, the blood is ready to be pumped into the body to deliver oxygen-rich blood to all bodily tissues. |
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Definition
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Term
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Definition
| Distributes oxygenated blood throughout the body, including the brain |
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Term
| In the womb, some blood enters right ventricle to pulmonary trunk. Instead of going to the lungs, blood goes to the ______ ______ via ductus arteriosis |
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Definition
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Term
| After birth, what two parts of the heart close? |
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Definition
| The foramen ovale and ductus arteriosis |
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Term
| Congenital anomalies include |
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Definition
1. Septal defects
2. Atrial Septal Defect (ASD) A "hole" in the wall that separates the top two chambers of the heart
3. Ventricular septal defect facts. VSD is a hole in the wall (septum) separating the ventricles of the heart. VSD is the most common type of heart malformation present at birth (congenital heart disease).
4. Patent Ductus Arteriosis - fails to close
5. Valvular stenosis - forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. |
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Term
| Common adult cardiac pathologies? |
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Definition
Congestive heart failure
Angina
Low ejection factor found in ECG |
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Term
| Which coronary artery supplies most blood to the heart? |
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Definition
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Term
| Contraindications for coronary arteriogram |
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Definition
Recent myocardial infraction
Recent CVA
Poor left ventricular function |
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Term
| 2 methods for coronary arteriogram |
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Definition
Sones Technique
*Brachial Approach by Cutdown
*Original Technique but Seldom Used
Judkins Technique
*Femoral Approach using Seldinger Technique
*Most commonly today
*Uses 1 of 3 catheter types
*Judkins' Right
*Judkins' Left
*Pigtail |
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Term
| What sets the Pigtail catheter apart from the Judkins? |
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Definition
| Multiple holes for high volume of contrast injection |
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Term
| Coronary arteriogram procedure |
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Definition
1. Femoral (or sometimes brachial/radial) artery accessed
2. Seldinger method applied
3. Contrast injected when entry into coronary artery is made |
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Term
| Volume of contrast used in coronary artery studies |
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Definition
| 7-10ml non-ionic water soluble iodine contrast |
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Term
| Volume of contrast used in ventriculogram studies |
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Definition
| 30ml non-ionic water soluble contrast |
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Term
| Procedures done with cardiac catheterization |
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Definition
Coronary angiogram
Ventriculogram
Selective cardiac catheterization
Angioplasty
Baloon septostomy |
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Term
| Selective cardiac catheterization procedure |
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Definition
1. Right cardiac catheterization
2. Insert catheter into a peripheral vein
3. Reach right atrium to right ventricle to pulmonary artery
Femoral artery approach - to thoracic artery (pressure is measured), advance to aortic arch ending in the left ventricle |
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Term
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Definition
| Surgical repair of a blood vessel |
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Term
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Definition
Using a baloon catheter, blocked vessel is repaired
Atherosclerosis hardens the walls of the blood vessel
A baloon-tipped catheter is inserted into the blood vessel
Once in place the balloon is inflated and deflated several times |
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Term
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Definition
An empty balloon with a catheter is inserted to the narrow part of the vessel
Using water pressure, the balloon is inflated
A small amount of contrast is injected to outline the balloon
Once done, the balloon and catheter are removed |
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Term
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Definition
The problem with balloon inflation - cracking of the walls of arteries
Stent - Stainless steel tube over a balloon
After inflating the balloon, the stents adhere to the vessel wall and keeps the vessel open |
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Term
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Definition
| Imaging the blood vessels after injecting contrast |
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Term
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Definition
Aneurysm
Stroke
Leg Pain
Chest pain
Headaches
Hypertension |
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Term
| Characteristics of carotid arteries |
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Definition
Right starts from right subclavian
Left starts from aortic arch
Branch into internal and external carotid arteries (at C3-C4)
External stops at mandible
Interal continues |
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Term
| Characteristics of internal carotid arteries |
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Definition
Goes up into the skull
Carotid siphon bifurcates into middle and anterior cerebral
Anterior supplies into frontal lobe
Middle to lateral side of brain |
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Term
| Both anterior cerebral arteries are connected by? |
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Definition
| Anterior communicating arteries |
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Term
| Posterior circulation characteristics |
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Definition
Vertebral arteries originate from the subclavian arteries
*Run through the transverse foramen of the cervical vertebrae
Both vertebral join at the pons of brain stem to form the basilar
Basilar artery bifurcates into right/left posterior cerebral arteries |
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Term
| What are the dural venous sinuses? |
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Definition
| Dural venous sinuses are venous channels located intracranially between the two layers of dura mater (endosteal layer and meningeal layer). |
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Term
| Indications of cerebral angiograms? |
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Definition
Occlusive diseases
*Atherosclerosis
*Thrombosis
*Emboli
Aneurysms
AV malformations
Fistulae |
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Term
| Contraindications of cerebral angiograms? |
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Definition
Contrast medium sensitivity
Severe intracranial bleeding
Advanced Arteriosclerosis |
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Term
| Direct Percutaneous Method (Angiogram) |
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Definition
Originally used - seldom used today
Head slightly extended and needle placed below carotid bifurcation
Disadvantages:
*Requires two needle sticks
*Reduces mobility of the head and neck positioning
*Hematoma in neck could impair breathing |
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Term
| Distal Catheterization (Angiogram) |
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Definition
Femoral artery with Seldinger technique
Safest and easiest
Most common complication is bleeding
Right axillary artery can be used
*Complication is damage to brachial plexus |
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Term
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Definition
1. Access femoral artery
2. Catheter inserted to abdominal aorta
3. Aortic arch reached
4. Once catheter reaches brachiocephalic or carotid, contrast is injected |
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Term
| Amount of contrast used in angiograms |
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Definition
| 5-10ml (type depends on anatomy) |
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Term
| Describe contrast injection phase of angiogram |
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Definition
After injection, 3 phases:
1. Arterial
2. Capillary
3. Venous
Each 2 second interval
Total of 7-10 seconds |
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Term
| Angiogram positioning and imaging |
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Definition
AP
MSP ⊥ to MSP
IOML ⊥ to film
Lateral
MSP parallel to film
IOML parallel to film |
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Term
| Local complications of angiogram |
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Definition
Bleeding and contrast extravasation at puncture site
Reduced by shorter procedure time and less catheter movement |
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Term
| Neurologic complications of angiogram |
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Definition
Seizures caused by contrast crossing the Blood Brain Barrier
Non-Ionic Contrast Reduces the effect |
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Term
| Systemic complications of angiogram |
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Definition
Contrast reaction (hypotension, heat pain)
Symptoms reduced by use of Non-ionic Contrast |
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Term
| Cerebral angiogram and AV malformation signs |
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Definition
IF:
Venous phase is seen during the arterial phase
OR
Dural sinuses are seen during arterial phase
Indicates malformation of AV system in brain |
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
What type of procedure is being performed?
[image] |
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Definition
| Pulmonary Artery Angiogram |
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Term
What artery is being demonstrated?
[image] |
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Definition
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Term
What artery is being demonstrated?
[image] |
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Definition
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Definition
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Definition
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Definition
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Term
| Carotid arteries bifurcate at? |
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Definition
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Term
| What are the blood vessels of the aorta? |
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Definition
1. Ascending Aorta
2. Aortic Arch
3. Descending Aorta
4. Right Brachiocephalic
5. Left Common Carotid
6. Left Subclavian |
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Term
| 3 main types of Aortic anyersums? |
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Definition
1. Saccular
2. Fusiform
3. Dissecting |
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Term
| Thoracic aortic angiogram - popular catheters? |
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Definition
Pigtail (lots of holes for contrast delivery)
Closed-End (Won't recoil) |
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Term
| Where is the pulmonary artery located? |
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Definition
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Term
| Uppper ext angios are accessed through? |
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Definition
Hand Vein
Anticubital Vein |
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Term
| The Celiac Axis is comprised of? |
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Definition
Left Gastric
Splenic
Hepatic |
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Term
| From superior to inferior, name the abdominal aortic branches |
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Definition
Celiac Axis
*Left gastric
*Splenic
*Hepatic
Superior Mesenteric
Renals
Inferior Mesenteric |
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Term
| From superior to inferior, name the Lower extremity aortic branches |
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Definition
Common Iliac
*Internal iliac
*External iliac
Femoral
Popliteal
Anterior Tibial
Posterior Tibial |
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Term
| The lower extremity aorta bifurcates at? |
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Definition
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|
Term
| Unpaired abdominal/lower ex aortic branches? |
|
Definition
Celiac trunk
Superior mesenteric
Inferior mesenteric |
|
|
Term
| The superior mesenteric branch supplies blood to what? |
|
Definition
Small Intestine
Ascending & Transverse Colon |
|
|
Term
| The inferior mesenteric branch supplies blood to what? |
|
Definition
| Distal transverse, descending, and sigmoid colon |
|
|
Term
| The inferior mesenteric branch is the ___ branch to come out of the aorta |
|
Definition
|
|
Term
| Renal Arteries Arise From Aorta at ______ between the SMA and IMA |
|
Definition
|
|
Term
| Blood returns to the IVC from the kidney by what? |
|
Definition
|
|
Term
| Which renal vein is longer? |
|
Definition
|
|
Term
| Which kidney is often used for transplant? |
|
Definition
|
|
Term
|
Definition
Femoral preferred
Translumbar or Axillary can be used
Initial injection should be above both
renal arteries |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
| Sir Humphrey Hounsfield (1972) |
|
|
Term
| Describe a 1st Gen CT scanner |
|
Definition
Rotates 180° around patient in a linear fashion (180 scans)
1-2 detectors w/pencil beam
Head only scans
5 min scan time
Interesting facts:
No scatter (pencil beam) |
|
|
Term
| Describe a 2nd Gen CT scanner |
|
Definition
Still rotates around patient (Still 180°)
Fan-shaped beam
20-second scan time
Body scans possible |
|
|
Term
| Describe a 3rd Gen CT scanner |
|
Definition
Tube and 750 detectors rotate around patient 360°
Curvilinear detectors
1-8 second scans
Problem with ring artifacts due to chable unwinding problem |
|
|
Term
| Describe a 4th Gen CT scanner |
|
Definition
360° detectors around patient
Tube rotates around patient
1200-4800 detectors in modern CT machine
Pros:
No ring artifact
Cons:
Cost
Radiation
Magnification |
|
|
Term
| Describe a Helical/Spiral CT scanner |
|
Definition
Latest
Single-breath hold
Table moves while scanner constantly rotates |
|
|
Term
| Difference between helical and conventional CT? |
|
Definition
Power supply to the tube is through slip-ring technology
Table moves as tube rotates
Data collection via interpolation |
|
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Term
|
Definition
Volume data is collected
Images formed at any table location
Slice location on table is difficult
Overlapping images are received (10mm thick, 5mm apart)
Slice thickness = collimation |
|
|
Term
| Pros/Cons of Spiral helical scanners |
|
Definition
Information gathered in a block instead of slice
Increased speed
Less contrast needed
Better 3D reconstruction
Less breathing artifacts
Multiplanar imaging possible
Used in Angio
CONS
Motion blurring (effective slice is thicker)
Data/image overload
Memory and Data Transfer May Be Limiting Factors |
|
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Term
|
Definition
|
|
Term
| While a pixel is 2D, a Voxel is different in that: |
|
Definition
| It's 3D, volumetric like a cube and has depth |
|
|
Term
In a CT setting, 0 indicates
Anything above is?
Anything below is? |
|
Definition
Water
Thicker than water
Thinner than water |
|
|
Term
|
Definition
Bone: +400 to +1000
Soft Tissue: +40 to +80
Water: 0
Fat: -60 to -100
Lung: -100 to -600
Air: -1000 |
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|
Term
| 3 layers of uterus (outer to inner) |
|
Definition
1. Serosa
2. Myometrium
3. Endometrium |
|
|
Term
| To be sure, a hysterosalpingogram is done _-_ days after the onset of menstruation |
|
Definition
|
|
Term
| Why are mild laxatives, suppositories, and an enema given for HSGs? |
|
Definition
| To clear out gas in the colon (sits behind the uterus) |
|
|
Term
| What position is a patient initally in for an HSG? |
|
Definition
|
|
Term
| What contrast shows up more on an HSG? |
|
Definition
|
|
Term
| Why is mostly water-based contrast used in HSGs? |
|
Definition
|
|
Term
| How much contrast for an HSG? |
|
Definition
|
|
Term
| What does endocrine produce? |
|
Definition
|
|
Term
| What does exocrine produce? |
|
Definition
|
|
Term
| What is the sphincter of Oddi? |
|
Definition
| A circular muscle embedded into the wall of the duodenum that controls the flow of bile and pancreatic juices into the duodenum |
|
|
Term
| What is the papilla of vater? |
|
Definition
| Opening where the duct joins duodenum |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Felix Bloch & Edward Purcell
1946 (Won Nobel Prize - 1952) |
|
|
Term
| What is Magnetic Resonance? |
|
Definition
A nuclei under a magnetic field will absorb and re-emit electromagnetic energy
This energy is at a specific resonance frequency
Depends on the strength of the magnet and other factors |
|
|
Term
| What did scientists originally intend MR to be used for? |
|
Definition
|
|
Term
| Who realized MR could be used for medicine? When? |
|
Definition
|
|
Term
| What originally made MR possible? |
|
Definition
|
|
Term
| Describe the first Brain MRI |
|
Definition
1971
Exam took 8 hours, pt. had to stay still
Images took 72 hours to develop |
|
|
Term
| Describe the first whole body MRI |
|
Definition
1977
Exam took 4 hours, 45 min |
|
|
Term
| By 1986, images were available within |
|
Definition
|
|
Term
| In 2003, who won the Nobel Prize for their discoveries in using MRI as a diagnostic tool? |
|
Definition
| Paul C. Lauterbur & Peter Mansfield |
|
|
Term
|
Definition
| A metal that pulls certain metals towards it or repels certain metals |
|
|
Term
| What is a permanent magnet? |
|
Definition
An object made from a material that is magnetized and has its own magnetic field
(ex: fridge magnets) |
|
|
Term
| What is a temporary magnet? |
|
Definition
| Made from soft metals, and only retain their magnetism while near a permanent magnetic field or electronic current |
|
|
Term
| What is an electromagnet? |
|
Definition
A soft metal core made into a magnet by the passage of electric current through a coil surrounding it
Can be turned on/off |
|
|
Term
|
Definition
Permanent (ceramic tiles)
- Low strength
- Electromagnet (2 types)
Resistive
- Medium strength (Copper/Aluminum)
- Can be turned on/off
Superconductive
- High strength
- Requires cyrogens for cooling
- Always on
- Used in MRI |
|
|
Term
| What is a superconductive magnet? |
|
Definition
Include ceramic metals
When below a freezing temperature, give no electric resistance
Cooled by helium or liquid nitrogen (cyrogens) |
|
|
Term
| Describe atomic principals of MRI |
|
Definition
Atoms have a nucleus
A nucleus has protons and neutrons
Each nucleus with an ODD number of protons have an inherent spin
Hydrogen has one proton and it has a spin
Those with an ODD number of protons spin along the axis of the nucleus |
|
|
Term
|
Definition
Protons carry electrical charge
They create a magnetic field when they spin
Hydrogen atoms in our body are randomly aligned and are constantly spinning |
|
|
Term
| Hydrogen atom characteristics |
|
Definition
Hydrogen atoms in our body are randomly aligned and are constantly spinning
When hydrogen atoms are in an outside magnetic field, the hydrogen atoms align with the outside magnetic field |
|
|
Term
| MRI and nuclear properties |
|
Definition
With no external magnet:
- Atoms randomly organized in body
With external magnet (MRI)
- Causes alignment along Z axis |
|
|
Term
| In MRI terms, the strong magnetic field is called? |
|
Definition
|
|
Term
| Why is the Hydrogen the element of interest in MRI? |
|
Definition
Hydrogen cells in the human body are:
- Abundant
- Stable
- Present strong magnetic properties |
|
|
Term
| The nuclei of Hydrogen atoms spin... |
|
Definition
Like a top, spinning in a circle
They also wobble |
|
|
Term
| MRI process (in a nutshell) |
|
Definition
Energy from an oscillating magnetic field is temporarily applied to the patient at the appropriate resonance frequency
The excited hydrogen atoms emit a radio frequency signal, which is measured by a receiving coil
As these coils are rapidly switched on and off, they create the "noise" of an MRI scan
The contrast between different tissues is determined by the rate at which excited atoms return to the equilibrium state |
|
|
Term
| What is the Larmor precession/frequency? |
|
Definition
| The precession of the magnetic moment of an object about an external magnetic field |
|
|
Term
|
Definition
1. Radio waves are applied to the magnet
2. Radio waves are transmitted through the coils
3. Electromagnetic field is produced
4. The hydrogen atoms that are aligned to the Z Axis get flipped into the X Axis
*The radio frequency must be similar to the Larmor Frequency*
5. Radio frequency is turned off
6. The atoms go back to Z Axis
7. Energy is released as radio waves
8. Picked up by the same coil that initially transmitted radio waves |
|
|
Term
|
Definition
Wo = L*M
Wo is the frequency of precession
L is the larmor constant, depending on the choice of atom: hydrogen, nitrogen, oxygen, etc.
M is the strength of the magnet |
|
|
Term
| The strength of a magnet is measured in? |
|
Definition
|
|
Term
| What is the range of Tesla for an MRI? |
|
Definition
0.2-3T
Stronger the magnet, stronger the signal |
|
|
Term
|
Definition
1. Radiofrequency Coils
2. Gradient Coils
3. Shim Coils |
|
|
Term
| Describe radiofrequency coils |
|
Definition
Used to send and receive signals from the body
Many types used for different types of exams
EX: Head, Body, & Extremity Coils |
|
|
Term
|
Definition
Length of Exam
Sensitivity to Metal
Sensitivity to Outside Electricity
No cardiac pacemaker
No defibralators
High cost
Longer imaging time
Patient implants
Special non-magnetic equipment needed |
|
|
Term
| Why are radiofrequency coils used? |
|
Definition
| To send and receive signals from the body |
|
|
Term
|
Definition
Used to produce homogeneity within the magnetic field of the MRI machine
Is placed inside the magnet |
|
|
Term
|
Definition
Gradients are loops of wire or thin conductive sheets on a cylindrical shell lying just inside the bore of an MR scanner. When current is passed through these coils a secondary magnetic field is created. This gradient field slightly distorts the main magnetic field in a predictable pattern, causing the resonance frequency of protons to vary in as a function of position. The primary function of gradients, therefore, is to allow spatial encoding of the MR signal.
Three sets of gradient coils are used in nearly all MR systems: the x-, y-, and z-gradients
X = Transverse
Y = Coronal
Z = Sagittal |
|
|
Term
| What are the 3 parameters of MRI? |
|
Definition
T1 Relaxation
T2 Relaxation
Spin Density |
|
|
Term
| Describe T1 Relaxation (Spin-Lattice) |
|
Definition
Longitudinal relaxation
Once the body is in the scanner, time it takes for a substance to become magnetized
Time it takes to regain longitudinal axis after a RF pulse
T1 is determined by the time it takes the thermal interaction to spread to the nearby molecules |
|
|
Term
|
Definition
Water - Moves fast
Fat - Moves @ Medium Speed
Proteins - Moves Slow
Is a relationship between movement of nuclei and Larmor frequency
- If both are similar, T1 is short
- Results in bright-looking tissue
Water moves fast but does not line up with Larmor frequency, resulting in dark appearance
Fat moves slower but movement is similar to larmor frequency so fat looks bright |
|
|
Term
| Describe T2 relaxation (Spin-Spin) |
|
Definition
Transverse relaxation
Measures how long T2 relaxation will be lost in an uniform magnetic field
Also measures how long protons can precess after an RF pulse
T2 decay is due to interaction that occurs between the spinning protons
Does not involve transfer of energy like T1
Refers to the wobbling (precession) of a nucleus in the X-axis
During RF signals, all nuclei is in phase
When nuclei begin to dephase, give out signal |
|
|
Term
|
Definition
T1:
Water: Dark
Fat: Bright
Longitudinal (Spin Lattice)
Shows Anatomy better
T2:
Water: Bright
Fat: Dark
Transverse (Spin-Spin)
Shows pathology better |
|
|
Term
| In T2, brightness is proportional to? |
|
Definition
Hydrogen concentration in the tissues
Air is dark due to no H
Water...duh |
|
|
Term
| MRI Anatomy vs. Pathology |
|
Definition
Cancer
T1 - Dark
T2 - Bright
CSF
T1 - Dark
T2 - Bright |
|
|
Term
| If contrast is being used in MRI, Pre-Contrast will always be... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is absolutely not allowed in or near an MRI machine? |
|
Definition
Cardiac pacemakers
Defibrillator
Aneurysm clips for at least 6 weeks after
Most prosthesis are safe |
|
|
Term
| Are pregnant women scanned in MRI machines? |
|
Definition
|
|
Term
MRI machines average ____db
Ear plugs typically bring them down to ____db |
|
Definition
|
|
Term
| Liquid _______ is used as a cyrogen for MRI |
|
Definition
|
|
Term
| When an MRI is unintentionally shut down, the cyrogen boils. What happens next? |
|
Definition
| The cyrogen forms a cloud and can reduce O2 levels in the room |
|
|
Term
| Before starting an MRI exam, you should check... |
|
Definition
| The heat and 02 levels in the room |
|
|
Term
| Instead of iodine, ________ is utilized for contrast in both injections and orally. |
|
Definition
|
|
Term
| List the benefits and applications of Gadolinium in MRI |
|
Definition
Does not cross the BBB
Useful in tumor enhancment
Used orally for GI studies
Injected for everything else
MRI contrast has para-magnetic properties |
|
|
Term
| List the types of artifacts in MRI |
|
Definition
RF interference
Metal objects inside/outside of pt.
Motion
Pt. touching RF coils |
|
|
Term
| What is used to combat "RF noise?" |
|
Definition
Faraday cage - Wire mesh keeps noise away
Covers the entire scanner |
|
|
Term
|
Definition
Excellent low contrast resolution
No ionizing radiation
Direct multiplanar imaging
No iodine contrast is used
Non-invasive |
|
|
Term
| Define low-contrast resolution |
|
Definition
| Ability to see tisue differences that are almost similar in density |
|
|
Term
|
Definition
| With research into atomic weapons |
|
|
Term
| How can an atom be split? |
|
Definition
Nuclear Fission: Split an atom
Nuclear Fusion: Fusing two atoms together (ex: hydrogen atoms fusing in the sun, giving us energy) |
|
|
Term
| When atoms are split quickly, what could happen? |
|
Definition
| It could have a harmful effect |
|
|
Term
|
Definition
Atom
- Smallest particle of an element that has the characteristics of that element
Element
- A pure substance consisting of atoms of the same atomic (Z) number
Isotope
- An element with a different mass (A) number
Radionuclide
- An isotope emitting Gamma rays (or X, B, A)
Labeling/Tagging
- Attaching a radionuclide to some substance |
|
|
Term
| Describe an atom's characteristics |
|
Definition
Very minute
Has protons, electrons, and neutrons
Is neutral because # of protons and electrons amount to same
Protons and neutrons are inside the nucleus |
|
|
Term
|
Definition
Carbon = 6 Protons / 6 Neutrons
Carbon 13 = 6 Protons & 7 Neutrons
Carbon 14 = 6 Protons & 8 Neutrons |
|
|
Term
| Atoms are extremely small, but when split... |
|
Definition
It exerts a massive amount of energy
Uranium has a larger atom size
-Used for nuclear weapons |
|
|
Term
|
Definition
a distinct kind of atom or nucleus characterized by a specific number of protons, neutrons, and energy state
There are 3700 different nuclides |
|
|
Term
| What are the different ways radioactive decay can occur? |
|
Definition
Decay of a nuclide
Nuclear fission
Electromagnetic radiation
Gives out energy or emits particle |
|
|
Term
| What are some radionuclide examples? |
|
Definition
Radium
Thorium
Uranium
Plutonium
Cecium
Cobalt |
|
|
Term
| What are the 3 emission types? |
|
Definition
Alpha (A, particles)
Beta (B, particles)
Gamma (G, rays) |
|
|
Term
|
Definition
| Particle radiation, cannot penetrate skin or even paper, can easily be stopped, harmful if ingested |
|
|
Term
|
Definition
| Particle radiation, emitted due to ejected electron, can penetrate paper but not wood or plastic |
|
|
Term
|
Definition
| Emitted from nucleus, can penetrate more than alpha or beta |
|
|
Term
| Radioactive material have nuclei with too much energy, _____ comes first, followed by ______ |
|
Definition
|
|
Term
| Define Physical Half-Life |
|
Definition
| Length of time for half of the radioactivity to disappear or decay |
|
|
Term
| Define Biological Half-Life |
|
Definition
| Length of time for half of the radioactivity to be eliminated from the body |
|
|
Term
| Define Effective Half-Life |
|
Definition
| Time required for the radioactivity in a body to be reduced by half by physical decay and biological elimination |
|
|
Term
| What do radiopharmaceuticals do? |
|
Definition
They are injected or orally taken
Then they cling onto specific organs
The drugs emit rays which detectors capture
Processed & displayed in computer |
|
|
Term
| Nuc Med drug administration types |
|
Definition
Injection
- Bone, Liver, Cardiac, Brain, Tumor
Ingestion
- Thyroid, Gastric Reflux and Emptying
Inhalation
- Lungs...no shit
Intrathecal (Into spinal column, arachnoid space)
- Cisternogram |
|
|
Term
|
Definition
|
|
Term
|
Definition
Hot Spot
- An area of increased activity
Cold Spot
- An area of decreased activity
Sensitivity
- The ability to detect or respond to a disease process
Specificity
- The ability to differentiate disease processes |
|
|
Term
|
Definition
Static
- Singular image of a particular structure, a "snapshot"
Whole body
- Moving detector for whole body (usually bone)
Dynamic
- Distribution over a specific time
SPECT (Single Photon Emission Computed Tomography)
- Sectional images much like CT or MRI |
|
|
Term
| Example of Nuc Med imaging process |
|
Definition
Radionuclide is administered
Imaged immediately for blood flow
Delayed imaging for collection in certain organs
Gamma rays emitted are detected by camera
Scintillation crystal on camera converts gamma rays to light energy |
|
|
Term
| Describe a scintillation camera |
|
Definition
The common detector in Nuc Med
When radiation hits the scintillation detectors, they emit a flash of light
Has crystal in the camera that converts the energy of photon in Gamma rays into flash of light
Is then detected by photo multiplier array |
|
|
Term
|
Definition
Safe
Very sensitive
Physiological Study
Early detection of pathology
Unlike XR, CT, & MR, Nuc Med demonstrates the function of anatomy
Tells how well an organ works
- Gallbladder study, Renal study |
|
|
Term
|
Definition
Radiotracer is taken by live cells
From there, can differentiate which part of the heart is dead after a heart attack |
|
|
Term
|
Definition
Poor resolution (lower spatial resolution than CT)
Poor anatomic detail
Intake of radioactive drugs
Cost
Cannot be around pregnant or breast-feeding women
Fear of Radionuclide Injection |
|
|
Term
| Measurement of Radioactivity |
|
Definition
Curie (CL) & Becquerel (Bq)
Radiography vs. Nuclear Medicine
Radiography (Curie) - Measures radiation activity
Nuclear Medicine (Becquerel) - Measures radiation decay |
|
|
Term
|
Definition
SPECT (Single Photon Emission Computed Tomography)
MUGA (Multigated Acquisition)
PET (Positron Emission Tomography |
|
|
Term
|
Definition
Single Photon Emission Computed Tomography
Radionuclide is INJECTED (thalium) or thalium 201
Patient put on a treadmill, stress test is done while images are acquired
2nd set of images done after some rest
Physician compares both images |
|
|
Term
| Equipment needed for SPECT |
|
Definition
You need a gamma camera to detect gamma radiation
Evolution of cameras:
- Single
- Two head cameras, 180° to each other, giving two images
- Three head cameras, 120° to each other, giving three images |
|
|
Term
| SPECT cameras with dual heads in L-shape is used for? |
|
Definition
|
|
Term
| SPECT cameras with triple head is used for? |
|
Definition
|
|
Term
| In SPECT, after images are acquired, what happens next? |
|
Definition
| They are reconstructed into axial, sagittal, and coronal planes |
|
|
Term
| Describe cardiac studies done on SPECT |
|
Definition
Called gated acquisition
Measures:
- Ejection rate of the heart
- Left ventricle pumping rate
- Myocardium thickness
Can all be evaluated |
|
|
Term
| With SPECT brain imaging, metabolic activity of the brain is related to the? |
|
Definition
Blood flow of the brain
In Alzheimer's pts. blood flow is low |
|
|
Term
| Other assorted images done on SPECT? |
|
Definition
Cardiac perfusion
Brain
Liver
Bone |
|
|
Term
|
Definition
|
|
Term
|
Definition
Radionuclide Technitium is added to red blood cells and injected back
The injected technetium along with the red blood cells travel to the heart
As blood pools in the heart, gamma rays are emitted
The function of the heart is then evaluated |
|
|
Term
| What is specifically evaluated in a MUGA scan? |
|
Definition
Ejection factors of the ventricles, especially the left ventricle
More accurate than EKG |
|
|
Term
|
Definition
Utilizes internally injected radioactive materials
PET is different from SPECT in the type of radionuclide used
PET's advantage is the ability to detect physiologic/metabolic changes prior to anatomic changes |
|
|
Term
|
Definition
F-18-FDG is injected
- Fluorine-18 is combined with glucose compound called FDG
- F-18-FDG is a glucose-based radionuclide
Tumors consume glucose 10 times more than normal cells
Once injected, FDG attaches to tumor cells
Radionuclide decays and emit the positron |
|
|
Term
| Describe PET scan and positrons |
|
Definition
F18-FDG emits a positive charged particle, AKA a positron
The positron travels only 1mm in our body before meeting an electron
Once they meet and collide, two gamma rays (photons) are produced |
|
|
Term
| Describe the physics of positron emission |
|
Definition
Positron emitted from the nucleus of an atom
Travels a short distance (approx. 1mm) and is captured by electron of opposite charge
On contact, both particles are annihilated
Their mass is converted into energy, two 511 KeV gamma rays or 2 photons
Emitted in opposite directions of 180° |
|
|
Term
| What happens after the two gamma rays (photons) are emitted during PET? |
|
Definition
The signals from the emitted gamma rays (2 photons) are detected and converted into digital image
Two detectors are needed to capture the two rays |
|
|
Term
|
Definition
It is a radionuclide generator
Non-radioactive isotopes are put in and radioactive nuclide are produced
PER (Positron emitting radiopharmaceuticals) are produced
Where F18-FDG is produced |
|
|
Term
|
Definition
F-18 produced in a cyclotron
Attached to FDG = F-18-FDG
Pt. is injected IV and waits 30-90min
Pt. is then placed on scanning bed
Imaging takes 20-40min |
|
|
Term
| How else is radionuclides produced? |
|
Definition
|
|
Term
|
Definition
Early detection of cancer
Cancer staging
Biopsy can be avoided if PET results are negative |
|
|
Term
| How can PET detect cancer? |
|
Definition
| Because Nuc Med analyzes function of a cell, any cellular changes can be detected, unlike MR/CT/XR |
|
|
Term
| How does Nuc Med assist with Neurological pathology? |
|
Definition
5-10%
Dementia & Alzheimer's
- Brain utilization of glucose with radioactive fluorine
- A decreased uptake (hypometabolism) is shown in the parietal and temporal lobes of Alzheimer's patients
Complex Partial Epilepsy
- FDG (Fluorodeoxyglucose) is used
- Affected areas show an increased uptake (hypermetabolism) during a seizure and a decreased uptake post seizure |
|
|
Term
| Leading Cancer types for Men & Women |
|
Definition
Men: Prostate & Lung
Women: Lung, Breast, Cervical |
|
|
Term
| What are some non-cancerous conditions treated with radiation therapy? |
|
Definition
Non-malignant tumors
Eye problems
Meningiomas
Hemangiomas |
|
|
Term
| What are some risk factors cancer? |
|
Definition
External
- Chemicals
- Viruses
- Radiation
Internal
- Hormones
- Genetic Mutations
- Immune System Disorders |
|
|
Term
|
Definition
Physicist/Chemist who pioneered radioactivity research
Discovered Radium & Polonium for medicine
Two-time Nobel Prize Winner - 1903 & 1911
Cobalt and Cecium units - 1900 |
|
|
Term
| (T/F) Radium is extremely unstable |
|
Definition
|
|
Term
| Radium Bromide & Radium Chloride was known for what? |
|
Definition
| Used as radionuclides to treat certain cancers & bone metastasis |
|
|
Term
| What is the unit of measurement for radioactivity of a material? |
|
Definition
|
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Term
|
Definition
RAD (Metric Unit)
- SI Unit = Gray
- 1 RAD = .01 Gray
REM (Roentegen Equivalent Man)
- 1 Rem = .01 Sievert |
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Term
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Definition
Radiation
- 75% are treated by radiation
Surgery
Chemotherapy |
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Term
| What is a new cancer treatment? |
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Definition
Stereotactic Radiation Surgery
Can treat Optic Nerve, Brain, and Spinal Cord Tumors
In-operable tumors are treated this way
Precise radiation in the shape of the tumor itself is delivered |
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Term
| What occurs when cancer cells are irradiated? |
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Definition
The cell's DNA is altered directly
or
Gives out free charged particles which damage the cell's DNA |
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Term
| Why are cancerous/abnormal cells are destroyed through radiation? |
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Definition
Greater number in mitosis
Greater number undifferentiated
Poor repair of abnormal cells |
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Term
| Which gene is responsible for regulating cell growth? |
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Definition
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Term
| What is a key difference between normal and cancer cells? |
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Definition
Normal cells grow and die; cancerous cells do not
A cancer cell separated from a tumor in 1951 is still growing |
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Term
| When is radiation therapy given? |
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Definition
Before surgery to shrink the tumor
During the surgery (RARE)
Post-surgery to kill the tumor that is inoperable |
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Term
| Describe the tumor classification system? |
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Definition
T = Presence of tumor & size
N = Node Involvement
M = Metastasis |
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Term
| Who are the people involved in radiation therapy? |
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Definition
Radiation Oncologist
- Prescribes dose
Medical Physicist
- Calibration & Maintenance of Equipment
Medical Dosimetrist
- Plan of delivery of treatment
Radiation Therapist
- Actual treatment and record keeping |
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Term
| Describe the roles of a Radiation Oncologist |
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Definition
Specializes in radiation therapy
Prescribes the dose of radiation of be delivered
It depends on the tumor's sensitivity to radiation
And the tolerance of nearby cells to radiation |
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Term
| Describes the roles of a medical Dosimetrist |
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Definition
Helps in planning the treatment
Selects the filters
Works with the therapists to see proper dosage is delievered |
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Term
| Describe the earlier Cobalt units used in radiation therapy |
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Definition
Developed in 1950s
Called "Cobalt Bomb" because of the heavy shielding involved
Cobalt 60 (a radioisotope) was used
Emits beta radiation but during the decay emits gamma radiation
Cobalt 60 has a half-life of 5.26 years
Radiation could not be switched on/off
Could not deliver high power radiation |
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Term
| What were Cobalt units replaced with? Why? |
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Definition
Linear accelerators
Why?
- High radiation given
However, Cobalt is still used due consistent, stable radiation |
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Term
| 3 kinds of radiation therapy? |
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Definition
1. External Radiation Therapy
2. Brachi Therapy (Internal)
3. Radio Isotope Therapy |
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Term
| External Radiation Therapy |
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Definition
1. 2D
2. Front to back
3. Sides |
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Term
| What equipment is used in External Radiation Therapy? |
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Definition
Simulator
- A CT scanner used to see structures involved in cancer
MD decides the area to be radiated, then marks it
After marking, radiation therapist does simulation (not actual radiation), takes about an hour
Patient has to stay still
- Immobilizing devices used
- Cradles
- Foam boxes
- Custom shaped molds |
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Term
| After immobilization devices are in place, what happens next? (ERT) |
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Definition
CT done
Images sent to computer for planning
- Treatment fields are determined
Oncologist marks edge of field with ink
-Dose calculated
- Dosimetrist also decides this |
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Term
| Types of beam used in ERT? |
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Definition
Single photon beam (single field)
- Spinal cord tumors treated this way
- Uterine tumors also |
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Term
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Definition
Single field - One port
- Suitable for skin cancer
Opposing field - Two ports
Multi-field - 3+ ports
Rotational field - Circular port movement with tumor at axis
Wedge field - Changing field strength
Shaped field - Irregular shaped field |
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Term
| Which ERT field type(s) help with precise tumor targeting and gives out least skin dose? |
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Definition
| Multi-field or rotational field |
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Term
|
Definition
120 kVp Superficial Unit
- Skin treatment
250 kVp Orthovoltage
- Moderately superficial
Colbalt-60 Gamma Ray
- 125 MeV for deeper treatment
Linear Accelerator
- 35 MeV or greater for deepest tumors
Photon Beam Therapy |
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Term
| Describe Brachytherapy / IRT |
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Definition
Radiation source placed in or near affected organ
These specific cancers benefit from this treatment:
- Cervical
- Breast
- Prostate |
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Term
| What is brachytherapy's radiation source? |
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Definition
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Term
|
Definition
X-Ray
- Electrons split
- Less harm
- Longer wavelength
Gamma
- Nucleus split
- More harm
- Shorter wavelength |
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Term
| Describe Radio Isotope Therapy |
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Definition
Radio Isotopes are injected
- Radio iodine for thyroid diseases
Targeted therapy
- In research now |
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Term
|
Definition
Placed in prostate area to better visualize and ERT is administered
Non-radioactive and shows prostate better for radiation treatment |
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Term
| (T/F) Radiation Treatment is painful |
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Definition
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Term
| Side effects of radiation therapy? |
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Definition
Weakness
Anemia
Epilation
Dryness of the skin & mouth
Later: Cancer |
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Term
| Benefits of radiation therapy? |
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Definition
Shrinks tumors
- Help in surgery
Some tumors are inoperable, but radiation helps
Esophageal & Spinal tumors shrink, less pressure against structures |
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Term
| If not careful, what could happen to a patient under radiation therapy? |
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Definition
Too much radiation
Negligent technologists
Bleeding at site
Discoloration |
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Term
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Definition
Treating cancer with chemicals
Killing cells that divide rapidly with drugs |
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Term
| Describe the characteristics of chemotherapy |
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Definition
Either injected, IV, or orally
Once in blood stream, targets dividing cells and stops mitosis
Attacks DNA-possessing nucleus of cells
Targets nucleus when dividing or copying genetic material
Makes side effects blatantly clear |
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Term
| What does chemotherapy specifically target? |
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Definition
Mitosis
Causes cells to die via apoptosis |
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Term
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Definition
Hair loss
Vomiting
Anemia
No appetite
Weakness
Affects immune system |
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Term
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Definition
1/9 women develops breast cancer
First radical mastectomy done in 1898
3 things done to diagnose:
- Mammogram
- Physical Exam
- Self Exam |
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Term
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Definition
Detects breast cancer
- Deaths have been greatly reduced due to early detection
Lung cancer now leading with women |
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Term
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Definition
Extends from 2nd-7th/8th ribs
Parts:
- Tail
- Areola
- Nipple
- Inframammary crease |
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Term
| The breast is divided into what 4 quadrants? |
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Definition
UOQ (Upper Outer Quadrant)
UIQ (Upper Inner Quadrant)
LOQ (Lower Outer Quadrant)
LIQ (Lower Inner Quadrant)
Divided by "clock" system |
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Term
|
Definition
Pectoralis muscle
- Chest Wall
Retro Mammary Space
Glandular Tissue
Ducts |
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Term
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Definition
Lobes
- 15-20 of them
- Each has lobules
- Each lobules have small alveoli
- Then duct
- Then ampula |
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Term
| Describe the chain of sequence for the breast |
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Definition
1. Lobes
- 15-20
2. Lobules
3. Small alveoli
4. Duct
- Drains into ampulla
5. Ampulla
- Drains out of Nipple
6. Nipple
Ampulla are activated for breast milk |
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Term
| What ligament provides support to the mammary glands? |
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Definition
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Term
| Types of tissues in the breast? |
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Definition
Glandular - Higher density
Fibrous - Higher density
Adipose - Less density
Glandular & Fibrous look brighter, Adipose darker on radiograph |
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Term
| What are the 3 types of breast? |
|
Definition
1. Fibro-Glandular
- Post-puberty to 30 years of age
- Highly dense, less fat
- Above 30 but never given birth
- Pregnant or lactating female
- More exposure factor
2. Fibro-Fatty
- Less dense
- Easier to penetrate
- Middle age (30-50)
- Fatty tissue increases
- Each pregnancy increases the amount of fatty tissue
3. Fatty
- Following menopause
- 50+ years old
- Lease dense tissue
- Children/Men are in this category |
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Term
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Definition
Remove jewelry
Remove talcum powder / deodorant
Causes artifacts
Fills out questionnaire
- # of pregnancies
- # of miscarriages
- Previous mammos
- Any scars, warts, moles, masses, tattoos, etc. |
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Term
| Describe XR tube for mammo |
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Definition
Molybdenum target
- Small focal spot, 0.3 & 0.1mm
- Utilize anode-heel effect
- Cathode on chest wall
- Anode on nipple
- AEC used
- Compression devices used |
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Term
| Breast configuration facts |
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Definition
Base of breast is near chest wall
Nipple area is apex of breast
Base is thicker than apex
Anode-heel effect compensates for difference |
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Term
| Describe mammo compression |
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Definition
Very uncomfortable
Benefit includes:
- Less tissue thickness
- Less scatter
- Breast structures closer to IR
- Less motion
- Breast structures separated
- Increases contrast
- Increased quality
- Less magnification |
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Term
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Definition
When ordered, magnification views are done, enlarging certain areas of interest (0.1mm FS used)
- A platform is inserted between IR and breast to shorten the distance
- Magnification similar to CXR |
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Term
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Definition
Much higher due to:
- Low KvP (25-28)
- Higher mA
- No bone |
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Term
|
Definition
Zero Mammogram
Film Screen Mammogram
Digital Mammogram |
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Term
| What other modalities deal with breast exams? |
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Definition
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Term
|
Definition
Performed on asymptomatic pts.
Craniocaudal (CC) AKA SUP-INF
Mediolateral Oblique (MLO) |
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Term
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Definition
Craniocaudal
Mediolateral Oblique
Mediolateral True Lateral
Exaggerated Craniocaudal Lateral |
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Term
| Describe Craniocaudal positioning (Mammo) |
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Definition
Only one breast done at a time
10X12
Shielded
Pt. usually standing or sitting
Breast lifted on cassette, 90° to IR
Nipple in profile
Breast is compressed to even out tissues
Shoulders relaxed, head turned away
Marker placed
Suspended breathing, expose |
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Term
| Craniocaudal evaluation criteria |
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Definition
Entire breast is shown
- Pectoral muscle visible
- Nipple in profile
- PNL (Posterior Nipple Line) within 1cm of MLO projection |
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Term
| MLO (Mediolateral Oblique) positioning (Mammo) |
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Definition
10X12
Pt standing or sitting
Pt's breast placed on screen
- Pulled away from chest wall, evening wrinkles out
- Compression used
CR angled 45°
- Perpendicular to breast
Suspending respiration |
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Term
| MLO (Mediolateral Oblique) evaluation criteria (Mammo) |
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Definition
Entire breast is seen
Inframammory line seen
Pectoral muscle is seen
Nipple seen in profile
Note: Pt asked to pull the other breast away from the one XRd |
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Term
| ML (Mediolateral) positioning (Mammo) |
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Definition
MD ordered only (Optional)
10X12
Pt standing, tube 90° to IR
Pull breast gently to include pectoral muscle
CR perpendicular
Compression applied
Marker placed |
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Term
| ML (Mediolateral) evaluation criteria (Mammo) |
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Definition
Lateral breast
Nipple in profile
Inframammory fold seen |
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Term
| Exaggerated Craniocaudal Positioning (Mammo) |
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Definition
Optional
Physician wants to see extra tissues for pathology reasons
Head turned
Rotate the body slightly
More axillary tissue included |
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Term
| For mammo, what measures must be taken for pts. with implants? |
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Definition
Manual exposure technique
Photo timer cannot catch the xrays from implants
Over-exposure may be needed |
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Term
| What is the Eklund method? |
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Definition
Mammo, pushing implants back
Anterior breast viewed |
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Term
| Needle biopsy method (mammo) |
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Definition
1. Localization
- Uses grid-type device
2. Marks with pen
3. Inserts needle/guide wire (painful)
4. Needle removed, guide wire in place |
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Term
|
Definition
MRI can demonstrate implants and dense breasts
- Shows rupture in implants well
- No radiation
Cons:
- Difficult positioning
- False positive
- Cost |
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Term
|
Definition
Mammogram is commonly followed by ultrasound
Shows benign and malignant lesions |
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Term
| Other reasons for mammograms? |
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Definition
Breast enlargement
Breast reduction
Breast reconstruction |
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Term
| Recent advancements in mammography |
|
Definition
Digital mammography
- Similar to standard mammography
- No films are used
- Faster
- Shorter exam time
- Pt. comfort
- Good for breast biopsies
CAD
- Computer-aided detection
- Double reading
- Helps in detecting breast cancer in a very early stage |
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Term
|
Definition
| Study of salivary gland with contrast |
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Term
| Purposes of salivary glands? |
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Definition
- Helps with digestion
- Mixes with food, easier to swallow
- Breaks down food
- Protects teeth from decay |
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Term
|
Definition
3 pairs of glands and associated ducts
- Parotid
- Submandibular
- Sublingual
Ducts communicate with mouth |
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Term
| Which salivary gland is the largest? |
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Definition
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Term
| Describe the parotid gland |
|
Definition
- Anterior to ear
- Inferior to ramus of mandible
- Posterior to mastoid
- Largest |
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Term
| Which duct is associated with parotid gland? |
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Definition
Parotid duct or Stensen's duct
- 5-7cm long
- Goes anterior and medial
- Connects to oral cavity at second molar level |
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Term
| What is a major disease of the parotid gland? |
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Definition
Mumps
- Caused by a virus
- It is a childhood disease
- Affects the parotid gland and obstructs the saliva from flowing into the mouth |
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Term
| Which gland is the second largest? |
|
Definition
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Term
| Describe the submandibular gland |
|
Definition
AKA submaxillary
Medial and inferior to body of mandible
Has submandibular/maxillary duct
- Wharton's duct
5cm in length
Courses anteriorly, medially to mandible
Enters oral cavity under tongue |
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Term
| What gland is the smallest? |
|
Definition
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Term
| Describe the sublingual gland |
|
Definition
- Narrow
- Enlongated
- Has 12 ducts |
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Term
|
Definition
Contrast study
- To see salivary gland opacified and see pathology
- Dilation of the ducts
- Fistula
- Strictures
- Obstruction of the ducts
- Stones
Can be a Pre-OP study |
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Term
| Pt complaints about saligoram are? |
|
Definition
Difficulty:
- Opening mouth
- Swallowing
Dry mouth due to lack of saliva production
Pain |
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Term
| Contraindications to sialogram? |
|
Definition
- Severe inflammation
- Infection
- Allergic to contrast medium
If severe inflammation/infection is present, sialogram is postponed |
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Term
| Pt. prepped for sialogram |
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Definition
- Remove jewelry
- Dentures
- Explain procedure
- Consent form signed |
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Term
| Equipment needed for sialogram? |
|
Definition
- XR with fluoro or CT room
- Sialography tray
- 3mm syringe
- Cotton swabs
- Sterile gauze
- Extension tubing
- Adhesive tape
- Cannula |
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Term
|
Definition
Pre-scout films taken
- Mandible AP, oblique, & true lateral
MD palpitates gland, gives pt lemon wedges to produce saliva
MD inserts cotton balls in palpitated area
Injects between tongue and site of interest
Has pt close mouth, gives local anesthesia
Tapes syringe filled with contrast along with extension tubing on shoulder
Contrast injected, fluoro used while slow injection
Takes spot films
Technologist repeats same scout images again |
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Term
| Contrast media used in sialography? |
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Definition
Oil or Water based
- Oil
- Highly opaque
- Slow excretion rate
- If calculi is indicated, oil is not used, cannot see stone
**Mostly water-soluble is used** |
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Term
| Describe water-soluble contrast for sialography |
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Definition
When calculi is suspected
If retention of contrast in the duct is suspected
Salivary glands are obstructed
Extravasation is expected
1-2ml of contrast used |
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Term
| Technical considerations for sialography? |
|
Definition
Suspend respiration OR have patient fill mouth with air and suspend respiration
Manual injection into duct or hydrostatic pressure injection
- Container must be 28" (70cm) above patient |
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Term
| Sialography positioning includes |
|
Definition
Spot films
- Pt supine
- Various head turning to see glands
- AP/PA
- Lateral oblique
- Mandible
Overhead
- AP Tangential
- PA Tangential
- Lateral or lateral oblique
- SMV |
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Term
| Patient positioning for parotid gland |
|
Definition
AP Tangential
- Pt. supine
- Rotate head toward the side of interest
- Parotid should be perpendicular to IR
- Ramus of mandible should be parallel to long axis of IR
PA tangential
- Pt. prone, rotate head to side of interest
- Parotid on side of interest should be perpendicular to IR
- Mandibular ramus is parallel to long axis of IR
Lateral Oblique
- Semi-prone
- Side of interest closest to IR
- Extend chin to clear spine
- Head in true lateral
- Front true lateral 15° toward IR
- CR 1" superior to mandibular angle
CR perpendicular, skims the mandibular ramus of side of interest
- Demonstrates parotid gland & duct |
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Term
| Patient positioning for submandibular |
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Definition
Lateral Oblique
- Semi-prone
- Side of interest closest to IR
- Extend chin to clear spine
- Head in true lateral
- From true lateral rotate 30° toward IR
- CR is at the inferior border of the mandibular angle
SMV
- Supine or upright
- IOML should be parallel to IR
CR perpendicular to a point on the MSP on a level with the mandibular angles |
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Term
| Evaluation criteria for sialography positions |
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Definition
Salivary duct opacified
Associated gland demonstrated
Marker visible |
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Term
| Post procedure for sialography |
|
Definition
Pt chews on citric-based gum or candy or lemon wedge to excrete saliva
Ear pain can sometimes occur
Instruct patient to contact MD if severe |
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Term
|
Definition
|
|
Term
| What does SONAR stand for? |
|
Definition
Sound Navigation and Ranging
Used to detect enemy submarines during WWII |
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|
Term
| When was SONAR first used for diagnostic medical purposes? |
|
Definition
|
|
Term
|
Definition
| Soundwaves greater than 20,000MHz |
|
|
Term
|
Definition
If mechanical stress is put on some material like crystals or quartz, and electric field is produced
Curie discovered this |
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|
Term
| Describe medical ultrasound |
|
Definition
| Uses 5-20MHz, high frequency waves |
|
|
Term
| When do we feel the pulse (ultrasound) in our body? |
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Definition
| When blood rushes through, oscillation or movement |
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|
Term
| Describe ultrasound transducers |
|
Definition
Convert electricity into sound = pulse
Convert sound into electricity = echo
The transducer has crystals
- When electricity hits the crystals, it changes shape
Electrical signal is produced
- Called Piezoelectric effect |
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|
Term
| What are the main principles of Ultrasound? |
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Definition
Electrical energy is transformed into mechanical energy
Pulse of sound sent to soft tissue
Sound interacts with tissue |
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Term
| Describe ultrasound "pulse" |
|
Definition
Pulse of sound that enters the soft tissue
It interacts with soft tissue which is the bio-effect
Pulse is determined by the transducer and the crystals used, not controlled by the operator |
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Term
| Describe ultrasound "echo" |
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Definition
Echo produced by soft tissues
Echoes are received by the transducer crystals
Echoes are interpreted and processed
Mechanical energy is transferred back into electrical energy |
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|
Term
| Describe ultrasound "window" |
|
Definition
When the transducer is used the medium though which the sound waves pass easily is called the "window"
The gel acts as the acoustic window |
|
|
Term
| Describe ultrasound coupling agent |
|
Definition
There is an air gap between the transducer and the organ
- Solved by the coupling agent
Gel, water, and mineral oil are all coupling agents |
|
|
Term
| How are transducers referred by? |
|
Definition
|
|
Term
|
Definition
2.5 MHz - Deep abdomen
3.5 MHz - General abdomen, OB/GYN
5.0 MHz - Vascular, Breast, GYN
7.5 MHz - Breast/Thyroid
10.0 MHz - Breast, Thyroid, Superficial veins, Superficial masses |
|
|
Term
| Ultrasound frequency rates |
|
Definition
One hertz = One cycle per second
One kilohertz = One thousand hertz
One megahertz = One million hertz
7.5 MHz = 7,500,000 |
|
|
Term
|
Definition
Some transducers have a range of frequencies
- 2.5-3.5 MHz for wider applications |
|
|
Term
| Higher and Lower frequency transducers |
|
Definition
Lower frequency
- General abdominopelvic areas
Higher frequency
- Superficial areas
Why?
- We use lower frequency transducer for deeper areas and higher frequency transducer for surface areas |
|
|
Term
|
Definition
How much sound waves are absorbed
Reduction in power as sound waves travel though a medium
Higher frequency attenuates or absorbed faster than the lower frequency
Lower frequency = lower penetration |
|
|
Term
|
Definition
If the sound waves are absorbed more by a structure - high attenuation
If the sound waves are absorbed less by a structure - low attenuation |
|
|
Term
| In ultrasound, where do you want your wavelength and frequency? |
|
Definition
Short wave, high frequency
- Produce shorter pulses and give better anatomic detail
Higher frequency
- Better image
- Better detail |
|
|
Term
| When is higher/lower frequency applied in ultrasound? |
|
Definition
Higher
- Superficial
- Penetration loss
Lower
- General abdomen
- Deep penetration
- Poor resolution |
|
|
Term
| Types of transducer types |
|
Definition
Mechanical
- Oscillating
- Rotating
Electric
- Linear array
- Curved array
- Phased array |
|
|
Term
| Electric Linear Transducer |
|
Definition
Transducer face is flat
- Produces rectangle-shaped images |
|
|
Term
| Electric Sector Transducer |
|
Definition
Transducer face is curved
- Produces pie-shaped images |
|
|
Term
|
Definition
No radiation
Non-invasive
Safe w/pregnant women |
|
|
Term
| Different applications of Ultrasound |
|
Definition
Babies - OB/GYN
Heart
Doppler
Prostate studies
Testicular cancer studies
Breast ultrasound
Gallbladder studies |
|
|
Term
| If there are stones in the gallbladder, you will see |
|
Definition
|
|
Term
|
Definition
Acoustic shadowing/enhancement
- Useful in diagnosis
- Ability to distinguish solid from cystic |
|
|
Term
|
Definition
Significant loss of sound posterior to a large mass
- Strong reflection: posterior to bone, stone
- Strong attenuation: posterior to mass |
|
|
Term
|
Definition
| Sound enhancement posterior to a cyst or weakly attenuating structure |
|
|
Term
| To detect irregularities of blood flow, what is used and why? |
|
Definition
Doppler
- Color-coded and displays blood vessels very clearly |
|
|
Term
| How are ultrasound images displayed |
|
Definition
A-Mode
- Displays depth in horizontal axis, good for ophthalmology where accurate distance measurement is required
M-Mode: Time, motion, good for cardiac valve images
B-mode: Static image of a section |
|
|
Term
| What is genetic ultrasound used for? |
|
Definition
Analyzing the anatomy for defects
- Down syndrome
- Cleft palate |
|
|
Term
|
Definition
Best modality to see defects of heart valve
Non-invasive
Can see the regurgitation or backflow of blood in a vessel in the heart |
|
|
Term
| If a mammogram is abnormal, where is the pt. sent next? |
|
Definition
|
|
Term
| Wht is pelvic ultrasound used for? |
|
Definition
Evaluate female sexual organs
- Cervix
- Ovaries
- Uterus
- Bladder
- Fallopian Tube
Pelvic ultrasound for male
- Bladder
- Prostate
- Seminal vesicles |
|
|
Term
| What does a prostate ultrasound do? |
|
Definition
Prostate enlargement
Infertility
Abnormal growth
Pt. complains
- Difficulty urinating
- Blood in urine
- Doctor felt a lump during physical |
|
|
Term
|
Definition
Cleansing enema prior to test
Drink 4-6 glasses of water to fill bladder |
|
|
Term
|
Definition
| Study of the spinal cord and nerve roots with contrast |
|
|
Term
| Common sites for a myelogram? |
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Definition
C, T, & L Spine
- Into subarachnoid space of spinal cord |
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Term
| The brain has 3 layers of membrance |
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Definition
Duramater
Arachnoid
Piamater |
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Term
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Definition
| Between duramater and arachnoid space |
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Term
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Definition
| Between arachnoid and piamater |
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Term
| Subarachnoid space contains? |
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Definition
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Term
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Definition
Lesion in the spinal cord
- Or protruding into the canal
Pain in lower/upper limb
Common lesion demonstrated are
- HNP
- Cancer, tumor, cysts |
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Term
| Contraindications for myelogram? |
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Definition
Blood in spinal cord
Contrast reaction
- Arachnoiditis
Increased intracranial pressure
Tapping the spinal cord will increase the pressure between the spinal cord and brain
Recent lumbar puncture
Contrast medium will leak into SAS through the hole left by previous procedure |
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Term
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Definition
Patient worried
- Talk/explain procedure
Muscle relaxant given 1hr before exam
MD explains procedure, complications
Pt. consent is given before exam |
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Term
| Equipment needed for Myelogram |
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Definition
Flouroscopy Room
Shoulder Braces
Foot Rest
Ankle Restraints |
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Term
| Accessory equipment needed for Myelogram |
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Definition
Sterile Tray
Gloves
Antiseptic lotion
Lab requisition
Sterile drapes
Razor
Syringes
Needles |
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Term
| Needle placement for Myelogram |
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Definition
2 puncture sites:
- L3-L4 for Lumbar
- C1-C2 for Cervical
Lumbar much safer
- Cervical done is lumbar is contraindicated
- If pathological conditions involve upper part of spine |
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Term
| Pt. positioning for Myelogram |
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Definition
Radiologist assesses the site
2 positions are chosen
- Prone w/pts. stomach on pillow
OR
- Left lateral
For C-Spine:
- Pt. seated or prone with head flexed
- Opens up interspinous space |
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Term
| Myelogram procedure steps |
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Definition
Technologist shaves area of interest
Cleans skin with antiseptic lotion
Dry with pads
Local anesthesia administered
- Zylocaine
Spinal needle is inserted into the subarachnoid space by MD
- CAUTION: Flouro tower lock ON!
Location verified by letting CSF flow
Sample collected, sent to lab
Contrast injected, needle out, band-aid
Images acquired |
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Term
| Contrast media for Myelogram |
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Definition
Air
Iodinated contrast media
Non-ionic water-soluble, iodine-based contrast is now used
- In the past: oil-based iodinated |
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Term
| Why is non-ionic water-soluble iodine used with Myelograms? |
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Definition
Easily absorbed
Mixes well with CSF
Non-toxic
Inert
Good radioopacity |
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Term
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Definition
Check for:
- Prior reactions
- Diabetes
- Diabetic medication (Certain meds are contraindicated)
- BUN, Creatine levels |
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Term
| Myelogram Contrast characteristics |
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Definition
Absorption is 30min
- Stays for up to 1hr
- Pissed out
6-17ml injected
Contrast media cannot enter head
- Hyper-extend neck to prevent
- Especially C-spine |
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Term
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Definition
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Term
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Definition
Overhead films taken by tech
- Cervical
- Cross table lateral
- Swimmer's lateral |
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Term
| Myelogram Cervical overhead positioning |
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Definition
Horizontal beam lateral
40" SID
Pt. prone
Hands at side, shoulders relaxed
CR at level of C4-C5
Sponge/towel under chin
Neck extended |
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Term
| Myelogram Swimmer's lateral overhead positioning |
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Definition
Horizontal beam
Pt. prone, chin extended
R arm down, L arm up above C7
- Shoulders depressed |
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Term
| Myelogram Thoracic overhead positioning |
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Definition
L/R Lat decubitus
- Both horizontal beam
- Vertical beam
AP
- Not recommended
- Supine position = contrast pools |
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Term
| Myelogram Lumbar overhead positioning |
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Definition
Semierect lateral
Pt. prone
Arms flexed above head
Table/Pt. semierect
Radiologist decides on table angle
CR @ L3
Additional images: Prone obliques |
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Term
| Why is a CT after myelogram done? |
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Definition
To see CSF leak
Obstruction of CSF |
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Term
| Evaluation criteria of Myelogram images |
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Definition
Spinal column with contrast media
Adequate penetration
Correct markers
Collimation |
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Term
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Definition
| Study of the joints with contrast medium |
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Term
| What type of joints studied in arthrogram? |
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Definition
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Term
| Joints included in arthrogram? |
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Definition
Knee
Shoulder
Elbow
Wrist
TMJ
Most common: Knee, Shoulder |
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Term
| Purpose of knee arthrogram? |
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Definition
See knee joint and related soft tissue
- Joint capsule
- Menisci
- Collateral, Criciate Ligaments
- Any tear of the ligaments
Reasons:
- Trauma
- Sports
- Ligament Tear
- Non-trauma: Baker's cyst |
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Term
| Arthrogram equipment needed |
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Definition
Flouroscopy
XR tube for horizontal beam
Arthrogram tray:
- Sponges, betadine, syringes, needle, connector, etc.
- Sterile gloves, steridrape |
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Term
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Definition
Clean site
- Shave
- Clean with antiseptic
- Dry with gauze
- Drape (middle opening)
- Contrast is drawn 5ml-10ml |
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Term
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Definition
MD injects anesthetic zylocaine
- 20GA mounted on 10ml syringe into the site selected
- Draws fluid
- If clear, no action taken
- If discolored, send to lab
- After the fluid is aspirated, contrast agent is injected
- If negative contrast needed, 50ml syringe with air is injected
- After contrast injection, needle removed
- Ace bandage is applied
- Knee is gently flexed
- Coats soft tissue |
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Term
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Definition
Spot films (10X12) taken by MD
Physician rotates pt. 20 degrees and takes many spot images at various angles |
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Term
| Arthrogram spot film eval criteria |
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Definition
- Meniscus center of film
- Correct exposure
- Markers
- M for medial, L for lateral |
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Term
| Overhead arthrogram images |
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Definition
Some facilities do
Horizontal XR beam
6 views on 14X17
- AP (pt. lateral, beam horizontal)
- Rotate 30 degrees between each exposure
- Ending in lateral |
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Term
| Reasons for shoulder arthrogram |
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Definition
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Term
| Needle used for shoulder arthrogram? |
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Definition
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Term
| Shoulder arthrogram procedure |
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Definition
Area cleaned
Site anesthetized
Physician inserts needle with fluoro guidance
Joint is deep so spinal needle used
Small amount of media contrast is injected
Physician checks if contrast has reached bursa
Injects all contrast media
Single or double contrast used
Single
- 10-12ml omnipaque
Double
- 3-4ml positive and 10-12ml negative |
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Term
| Shoulder arthrogram positioning |
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Definition
Scout: AP, INT/EXT
Transaxillary, humeral head
Pt. is asked to exercise shoulder so contrast coats evenly on shoulder
Post-procedure:
Less stress
Ice |
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Term
| Why is bone densitometry done? |
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Definition
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Term
| What do osteoblasts/-clasts do? |
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Definition
Osteoblasts: Build
Osteoclasts: Remove |
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Term
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Definition
Bone Mineral Content (BMC)
- Measurement of the quantity or mass of bone in grams |
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Term
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Definition
Bone Mineral Density (BMD)
- Ratio of BMC to area calculated in units: G/CM to the power of 2 |
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Term
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Definition
| Compares the pt with an average individual of the same sex and age |
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Term
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Definition
| Compares pt with an average, young healthy adult with peak bone mass |
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Term
| People at risk for osteoporosis? |
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Definition
Estrogen-deficient individual
Family history of fractures
Aneroxia pts |
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Term
| Equipment needed for bone densitometry? |
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Definition
Dual energy XR absorptiometry
DXA
Radiation very low
1-30 microsiverts
CT also done
- Dose is higher
For peripheral site Ultrasound is used |
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Term
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Definition
Real BMD measured in g/cm²
“T-score” compares the patient’s BMD
with the young-normal mean BMD and expresses the difference as a standard
deviation (SD) score |
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Term
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Definition
pts. BMD - Young-adult mean BMD
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1 SD of young-adult mean BMD score |
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Term
| DXA diagnostic calculation |
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Definition
Normal: -1 or greater
Osteopenia: Between -1 and -2.5
Osteoporosis: -2.5 or less
Severe osteoporosis: -2.5 or less and fragility fracture |
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Term
| Common sites for bone density studies |
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Definition
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Term
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Definition
Supine on table
MSP aligned with table
Support sponge under knees
Center at IC
Area done: T-12 to crest
Analysis done between L1 or L2 to L4 |
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Term
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Definition
Supine on table, MSP aligned
Like AP hip, rotate leg in
Center on groin area |
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Term
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Definition
Too thin: difficult to get a tissue analysis
Too heavy
Scoliosis
Cannot do on pregnant women |
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Term
| What is displayed on a DXA image? |
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Definition
A bone mineral image
Measurements
Compared standards
Chart is also produced |
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Term
| DXA preventative measures |
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Definition
Drugs for bone absorption
Calcium intake
Estrogen replacement |
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Term
| Myelogram / Arthrogram / DXA comparasion |
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Definition
Myelogram:
- C, T, L-Spine
- 6-17ml used (iodinated, air)
Arthrogram
- Knee, Shoulder, Hip, Wrist
- Knee: 5-10ml (Air, iodinated)
- Shoulder: 10-12ml (Air, iodinated)
DXA
- L-spine, Hip, Forearm, Hand
- No contrast |
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