additional slides from 6/23/09
TRANSCRIPT
INTRODUCTION to INTRODUCTION to RADIOLOGYRADIOLOGY
Carol P. Becker, M.D.Carol P. Becker, M.D.
Stephanie Casey, M.D.,M.P.H.Stephanie Casey, M.D.,M.P.H.
MAIN ADVANTAGES MAIN ADVANTAGES OF OF
CTCT OVER MRI OVER MRI
Rapid scan acquisitionRapid scan acquisition
Visualization of Visualization of cortical cortical bonebone and soft tissue and soft tissue calcificationscalcifications
Multi-Detector (Helical) CTMulti-Detector (Helical) CTmultiple planes of detectors in the multiple planes of detectors in the
gantrygantry
Technical innovation allowsTechnical innovation allows
– even even fasterfaster scanning scanning
– over a much longer rangeover a much longer range
– with even better image qualitywith even better image quality
Radiation exposure greater than single-Radiation exposure greater than single-detector CTdetector CT
“ “Total body” CT in trauma ptsTotal body” CT in trauma pts
1616TB Cavity w FBCT SCAN
NormalNormal
Trachea
Aorta
Interlobarartery
Rt interlobarartery
Confluent shadow of right interlobarartery and superior vein
Lt interlobarartery
Spine Note:Density is darkerinferiorlyRt diaphragm
Chest RadiologyChest Radiology
Pneumothorax: “Pneumothorax: “deep sulcus” signdeep sulcus” sign
Pneumonia or Pulmonary Edema Pneumonia or Pulmonary Edema Airspace Disease:Airspace Disease:
Silhouette Sign & Spine SignSilhouette Sign & Spine Sign
PneumoperitoneumPneumoperitoneum: perforated : perforated viscusviscus
Right pneumothoraxRight pneumothorax
Lingular PneumoniaLingular Pneumonia
NL?
PNEUMO
PERITONEUM
PLAIN RADIOGRAPH
Hounsfield Unit Scale Hounsfield Unit Scale (CT Attenuation)(CT Attenuation)
Gas (Air)Gas (Air) -1,000 HU-1,000 HU
FatFat -100 HU-100 HU
WaterWater 0 HU0 HU
Soft tissueSoft tissue +20 to +100 HU+20 to +100 HU
BoneBone +1,000 HU+1,000 HU
Radiographic DensitiesRadiographic Densities
Metal Very WhiteMetal Very White
BoneBone White White
Water GrayWater Gray
Fat Gray-BlackFat Gray-Black
Air BlackAir Black
Metal is most Metal is most RadiodenseRadiodense oror Radiopaque Radiopaque. .
Air is most Air is most RadiolucentRadiolucent..
HOUNSFIELD UNIT SCALEHOUNSFIELD UNIT SCALE
Compares Compares attenuationattenuation of of each each tissuetissue through which through which the x-ray beam passes with the x-ray beam passes with the attenuation of the attenuation of WATER.WATER.
Common Indications for Common Indications for IV ContrastIV Contrast in in CTCT
To visualize To visualize blood vesselsblood vessels (Aortic injury, Abdominal Aortic Aneurysm, (Aortic injury, Abdominal Aortic Aneurysm, Pulmonary Embolus)Pulmonary Embolus)
To evaluate for primary or To evaluate for primary or metastatic metastatic tumortumor
To evaluate for To evaluate for infectioninfection or or inflammatoryinflammatory processes processes
To evaluate for To evaluate for traumatictraumatic injury injury
RLQ pain
in a 20 year old male
Appendicitis
Angiography uses intravenous contrast Angiography uses intravenous contrast mediummedium
depts.washington.edu/.../depts.washington.edu/.../brain_aneurysm.htmlbrain_aneurysm.html
rtg.misto.cz
2222RUQPAINUSound Cholelithiasis = Gallstones
ULTRASOUNDULTRASOUND of Deep Venous of Deep Venous ThrombosisThrombosis
Occlusive, LT UEOcclusive, LT UE
2222RUQPAINUSound Cholelithiasis = Gallstones
CONTRAINDICATIONS for CONTRAINDICATIONS for MRI SCANNING:MRI SCANNING:
PacemakersPacemakers, pacing wires (RF current can , pacing wires (RF current can induce cardiac arrhythmias, burns)induce cardiac arrhythmias, burns)Cerebral Cerebral aneurysm clipsaneurysm clips (movement, burns, (movement, burns, induced electrical currents)induced electrical currents)Implants (insulin pumps, Implants (insulin pumps, cochlear implantscochlear implants, , neurostimulator, drug infusion pumps, penile neurostimulator, drug infusion pumps, penile and dental implants)and dental implants)Intra-Intra-orbitalorbital metallic fragmentsmetallic fragments (may deflect in (may deflect in magnetic field, causing injury/blindness), XRay magnetic field, causing injury/blindness), XRay orbits if unsureorbits if unsure
Under InflationUnder Inflation
Over InflationOver Inflation
OpacificationOpacification
Radio opacity is a Radio opacity is a white density on a white density on a filmfilm
Can be a Foreign Can be a Foreign Body, Pneumonia, Body, Pneumonia, Atelectasis, or Atelectasis, or ArtifactArtifact
InfiltrateInfiltrate
Non-specific Lung pathology Non-specific Lung pathology
Can be Pneumonia or AtelectasisCan be Pneumonia or Atelectasis
AtelectasisAtelectasis
Means AirlessnessMeans Airlessness
Usually associated Usually associated with Volume losswith Volume loss
Secondary to Secondary to – mucus plugging mucus plugging
(Asthma), (Asthma), – Foreign BodyForeign Body– Endo-Bronchial lesion Endo-Bronchial lesion
-less likely--less likely-
Which Lung Is Sick?
Pleural EffusionPleural Effusion
Air BronchogramAir Bronchogram
Interstitial Lung DiseaseInterstitial Lung Disease
Lobar PneumoniaLobar Pneumonia
Alveolar lung Alveolar lung DiseaseDisease
Usually Bacterial Usually Bacterial (needs Antibiotics)(needs Antibiotics)
Rule 5Rule 5
Needs to have 2 Needs to have 2 good Diaphragms good Diaphragms on Lateral Viewon Lateral View