AHM 244 AHM 244 Introduction to Introduction to Imaging Imaging
Dec 14, 2015
Principles of RadiologyPrinciples of Radiology
X-rays (discovered late 19X-rays (discovered late 19thth century) century) Computed Tomography (CT scan)Computed Tomography (CT scan) Sonography (ultrasound)Sonography (ultrasound) FluoroscopyFluoroscopy Nuclear Medicine – used for diagnostic Nuclear Medicine – used for diagnostic
and therapeutic proceduresand therapeutic procedures Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI) Positron Emission Tomography (PET)Positron Emission Tomography (PET)
X-raysX-raysRadiographyRadiography High energy waves that High energy waves that
cannot be seen or feltcannot be seen or felt
Similar to photographsSimilar to photographs
Radiopaque – do not Radiopaque – do not permit passage of x-rays permit passage of x-rays i.e. bones; show up on x-i.e. bones; show up on x-rayray
Radiolucent – permit the Radiolucent – permit the passage of x-rays i.e. soft passage of x-rays i.e. soft tissue; do not show up on tissue; do not show up on x-rayx-ray
X-raysX-raysPatient PositioningPatient Positioning
2-dimensional2-dimensional
Requires 2 exposures 90 degrees Requires 2 exposures 90 degrees to each otherto each other
May require multiple positions May require multiple positions and viewsand views
Review standard positions in Review standard positions in handouts and in texthandouts and in text
Review exam sequencing in textReview exam sequencing in text
http://www.rtstudents.com/radiolhttp://www.rtstudents.com/radiology-positions.htmogy-positions.htm
Radiation SafetyRadiation Safety Can cause cellular or genetic Can cause cellular or genetic
damagedamage
Minimize exposureMinimize exposure
Avoid unnecessary examsAvoid unnecessary exams
Limit area of body exposedLimit area of body exposed
Shield sensitive body partsShield sensitive body parts
Pregnancy statusPregnancy status
Workers:Workers:
Use shieldingUse shielding Wear dosimeterWear dosimeter
Diagnostic ProceduresDiagnostic Procedures
Mammography – Mammography –
x-ray examination of x-ray examination of the breastthe breast
Vital adjunct to Vital adjunct to biopsybiopsy
Performed yearly Performed yearly after age 40 or after age 40 or sooner with history sooner with history or suspicion or suspicion
Diagnostics cont…Diagnostics cont…Contrast StudiesContrast Studies
Used to differentiate Used to differentiate structuresstructures
Introduced via IV, catheter, Introduced via IV, catheter, orallyorally
Iodine – blood vessels; if Iodine – blood vessels; if allergic to shellfish, do not allergic to shellfish, do not use iodine!use iodine!
Barium – intestines and Barium – intestines and stomachstomach
Air - JointsAir - Joints
FluoroscopyFluoroscopy Use of x-rays to observe Use of x-rays to observe
movement within bodymovement within body
Contrast mediums used Contrast mediums used such as barium or such as barium or iodineiodine
Blood flow, beating Blood flow, beating heart, digestive tract heart, digestive tract
Also used to aid in Also used to aid in reducing fractures or reducing fractures or implanting devices such implanting devices such as pacemakers, stents, as pacemakers, stents, etc..etc..
Computed TomographyComputed Tomography Cross-sectional group of Cross-sectional group of
x-rays that target a x-rays that target a specific sitespecific site
Tube circles the patient, Tube circles the patient, computer analyzes to computer analyzes to create the cross-create the cross-sectional viewssectional views
Done with and without Done with and without contrast contrast
Organs can be viewed Organs can be viewed from all anglesfrom all angles
SonographySonographyUltrasoundUltrasound Non-invasiveNon-invasive
Uses high-frequency Uses high-frequency sound wavessound waves
Creates cross-sectional Creates cross-sectional still views or views in real still views or views in real time movement with help time movement with help of a computerof a computer
Used for heart function, Used for heart function, abdominal and pelvic abdominal and pelvic structure views and fetal structure views and fetal visualizationvisualization
MRIMRIMagnetic Resonance ImagingMagnetic Resonance Imaging
Uses high-intensity magnetic Uses high-intensity magnetic fields (magnets), radio waves and fields (magnets), radio waves and computer analysis to create computer analysis to create cross-sectional imagescross-sectional images
Used for central nervous system Used for central nervous system studies, joint structure, etc.studies, joint structure, etc.
Done with or without contrastDone with or without contrast
Claustrophobia is an issueClaustrophobia is an issue
Metal implants from surgeries is Metal implants from surgeries is a contraindicationa contraindication
Patient must remove any jewelry Patient must remove any jewelry and other metal objectsand other metal objects
Nuclear MedicineNuclear Medicine Small amounts of radionuclides Small amounts of radionuclides
(radioactive materials) are injected(radioactive materials) are injected
These concentrate in specific areas These concentrate in specific areas of bodyof body
Computer cameras detect particles Computer cameras detect particles and create an imageand create an image
Used to study thyroid, brain, lungs, Used to study thyroid, brain, lungs, liver, spleen, kidney, bone and liver, spleen, kidney, bone and breastbreast
Positron Emission Tomography Positron Emission Tomography (PET)(PET)
Single Photon Emission Computed Single Photon Emission Computed Tomography (SPECT)Tomography (SPECT)
Assists with diagnosis of cellular Assists with diagnosis of cellular abnormalities esp. cancerabnormalities esp. cancer
Interventional Radiologic Interventional Radiologic ProceduresProcedures
Designed to treat specific disease conditions – helps patients Designed to treat specific disease conditions – helps patients avoid surgeries, life-savingavoid surgeries, life-saving
Percutaneous Transluminal Coronary Angioplasty Percutaneous Transluminal Coronary Angioplasty (PTCA)(PTCA) – balloon angioplasty; used to enlarge lumen of – balloon angioplasty; used to enlarge lumen of blocked arteryblocked artery
Laser AngioplastiesLaser Angioplasties – use lasers to remove deposits in – use lasers to remove deposits in vesselsvessels
Vascular StentsVascular Stents – plastic or wire tubes inserted into a – plastic or wire tubes inserted into a constricted vessel to open it; this procedure is guided by constricted vessel to open it; this procedure is guided by fluoroscopyfluoroscopy
EmbolizationsEmbolizations – artificially stop bleeding from a blood – artificially stop bleeding from a blood vessel or reduce blood flow to a diseased area of an organ vessel or reduce blood flow to a diseased area of an organ
Radiation TherapyRadiation Therapy Major force in fight against Major force in fight against
cancercancer
Uses high-energy radiation to kill Uses high-energy radiation to kill cancer cellscancer cells
Used in conjunction with surgery Used in conjunction with surgery and chemotherapy (drug therapy)and chemotherapy (drug therapy)
Precise and carefully planned by Precise and carefully planned by radiation oncologist (MD radiation oncologist (MD specializing in radiology)specializing in radiology)
Each treatment must be identical Each treatment must be identical to a specifically defined area of to a specifically defined area of the bodythe body
Side effects: weight loss, hair Side effects: weight loss, hair loss, loss of appetite, skin loss, loss of appetite, skin changes, digestive system changes, digestive system disturbancesdisturbances
Patient Education & Patient Education & PreparationPreparation
Help alleviate anxietyHelp alleviate anxiety Calm fearsCalm fears Explain proceduresExplain procedures Explain preparation – different for Explain preparation – different for
each test from no prep to liquid diet each test from no prep to liquid diet and laxativesand laxatives
Assist as needed Assist as needed Post procedure educationPost procedure education
Handling and Storage of Handling and Storage of Radiographic FilmsRadiographic Films
Protect unexposed films from extremes of temperature and lightProtect unexposed films from extremes of temperature and light Exposed films kept in protective sleevesExposed films kept in protective sleeves Maintain patient confidentiality per HIPAAMaintain patient confidentiality per HIPAA Correct labeling of patient filmsCorrect labeling of patient films Films obtained on site remain part of patient record – films Films obtained on site remain part of patient record – films
belong to the site that performed the procedure; can be signed belong to the site that performed the procedure; can be signed out by patient or sent by courier to specialist or PCPout by patient or sent by courier to specialist or PCP
Digital films can be kept in the EMRDigital films can be kept in the EMR Written summary sent to providers of patient care Written summary sent to providers of patient care
Teleradiology – computed imaging and information systems; many Teleradiology – computed imaging and information systems; many places use (PACS) Picture Archiving and Communication System places use (PACS) Picture Archiving and Communication System to store films on computersto store films on computers
Can outsource films this way to other countries even for a Can outsource films this way to other countries even for a radiologist to read films; consults with specialists from around radiologist to read films; consults with specialists from around the world is possible with this system and in rural areasthe world is possible with this system and in rural areas