Diagnostic Radiology

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Diagnostic Radiology The basics : 

Diagnostic Radiology The basics Dr Muhammad Ishfaq Dr Tamar Saeed surgical C, Khyber teaching hospital, Peshawar. Pakistan 2009

Radiological Modalities : 

Radiological Modalities X-Ray Projection (plain Radiography) Fluoroscopy CT scan MRI Ultrasound Nuclear medicine

X-Rays/Plain Radiography : 

X-Rays/Plain Radiography Wilhelm Conrad Röntgen (27 March 1845 – 10 February 1923) German physicist, who, on 8 November 1895, produced and detected electromagnetic radiation in a wavelength range today known as x-rays or Röntgen rays, an achievement that earned him the first Nobel Prize in Physics in 1901.

Types of Plain Radiography : 

Types of Plain Radiography A .Film-Screen Radiography X-Rays passes through body and strikes a cassette containing fluorescent phosphorus. The area with high radiation will appear 1.black 2.gray The area with less radiation will appear 3.lighter 4.white B .Computed Radiography (CR) The x-rays passing through the patient strike a sensitized plate which is then read and digitized into a computer image by a separate machine C. Digital radiography The x-rays strike a plate of x-ray sensors producing a digital computer image directly

Fluoroscopy : 

Fluoroscopy Special applications of X-ray imaging, in which a fluorescent screen or image intensifier tube is connected to a closed-circuit television system. This allows real-time imaging of structures in motion or augmented with a radio contrast agent. Radio contrast agents ,To delineate anatomy and functioning of the blood vessels, the genitourinary system or the gastrointestinal tract. Radio contrasts Barium (as BaSO4) for evaluation of the GI tract. Iodine Air, can be used as a contrast agent for the gastrointestinal system Carbon dioxide, can be used as a contrast agent in the venous system;

CT scan : 

CT scan These are x rays Greek ‘tomos’ means slice & ‘graphein’ writing n 1900 an Italian gives the idea First commercially available in 1972 in UK

CT SCAN : 

CT SCAN .CT imaging uses X-rays in conjunction with computing algorithms to image the body. In CT, an X-ray generating tube opposite an X-ray detector (or detectors) in a ring shaped apparatus rotate around a patient producing a computer generated cross-sectional image (tomogram). Acquired in the axial plane, while coronal and sagittal images can be rendered by computer reconstruction. Radio contrast agent Intravenous contrast can allow 3D reconstructions of arteries and veins

Ultrasound : 

Ultrasound In physics the term "ultrasound" applies to all acoustic energy with a frequency above human hearing (20,000 hertz or 20 kilohertz). Typical diagnostic sonographic scanners operate in the frequency range of 2 to 18 megahertz, hundreds of times greater than the limit of human hearing

ULTRASOUND : 

ULTRASOUND Uses ultrasound (high-frequency sound waves) to visualize soft tissue structures in the body in real time Highly dependent on the skill of the person (ultrasonographer) NO RADIATION SAFE OBSTETRICAL USE THERAPEUTIC USE

Modes of sonography : 

Modes of sonography A-mode: A single transducer scans a line through the body with the echoes plotted on screen as a function of depth. Therapeutic ultrasound aimed at a specific tumor or calculus is also A-mode, to allow for pinpoint accurate focus of the destructive wave energy. B-mode: In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. M-mode: M stands for motion. In m-mode a rapid sequence of B-mode scans whose images follow each other in sequence on screen enables doctors to see and measure range of motion, as the organ boundaries that produce reflections move relative to the probe. Doppler mode: This mode makes use of the Doppler effect in measuring and visualizing blood flo

MRI : 

MRI Magnetic resonance imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize the structure and function of the body. It provides detailed images of the body in any plane. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging. Unlike CT, It uses no ionizing radiation, but uses a powerful magnetic field to align the nuclear magnetization of (usually) hydrogen atoms in water in the body

MRI : 

MRI MRI scans give the best soft tissue contrast of all the imaging modalities MRI has become an essential tool in musculoskeletal radiology and neuropathology

NUCLEAR MEDICINE : 

NUCLEAR MEDICINE Nuclear medicine imaging involves the administration into the patient of radio pharmaceuticals consisting of substances with affinity for certain body tissues labeled with radioactive trace. The most commonly used tracers are Technetium-99m, Iodine-123, Iodine-131, Gallium-67 and Thallium-201. The heart, lungs, thyroid, liver, gallbladder, and bones are commonly evaluated for particular conditions using these techniques. Anatomical detail is limited in these studies, nuclear medicine is useful in displaying physiological function. With computer processing, the information can be displayed as axial, coronal and sagittal images (SPECT images) In PET scanning, a radioactive biologically-active substance, most often Fluorine-18 Fluorodeoxyglucose, is injected into a patient and the radiation emitted by the patient is detected to produce multi-planar images of the body.

Pre investigation preparations : 

Pre investigation preparations

Contraindications : 

Contraindications

Radiological hazards : 

Radiological hazards

Radiological hazards : 

Radiological hazards

Extravasations (1)Dehydration (& cell death)of surrounding tissues  and (2)Compartment syndrome-  Treatment: i. RICE (Rest, Ice-pack, Compress, Elevate extremety    ii. Watch for compartment syndrome, especially if large volum Contrast induced nephrotoxicity Defined as a 25% increase in serum creatinine   -  Prevention:              -   i. Any high risk factors: Pre-hydrate patient              -   iii. Space out contrast studies 72h apart, if possible (e.g. cancer staging)              -   iv. Consider non-contrast CT or alternate studies (e.g. US, MRI)   - Paradoxically, patients whose kidneys have already failed and are on dialysis can ignore all the above. Acute Hazards and management

Acute hazards and management : 

Acute hazards and management (4) Metformin-induced lactic acidosis   -   Metformin: Stop on the day, and 2 days after the scan.   -  Once again, do this proactively, if you think patient might be going for a contrast-CT soon!       (Just don’t forget to convert to insulin/another OHGA, and to re-start it later!) (5) Breast feeding   -   Can scan as per normal, but no breast feeding x 24h after the scan (6)Allergic reaction Management as for other drugs. prednisolone

Thank you : 

Thank you

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