RDSC 233 Mid-term Review The following slides highlight the information covered through the unit on the colon. 1. Terminology from the units 2. Review.

RDSC 233 Mid-term Review

The following slides highlight the information covered through the unit onthe colon.

1. Terminology from the units2. Review questions with answers 3. Index of pathology from each unit 4. Technique factors from each unit5. Images

Chest:nasogastric (NG) tubeendotracheal (ET) tubeSOBdyspneaangina sputumhemoptysis fibrile/afibrileaspirationchronic/acuteheart mummerhyaline membrane diseaseempyemathoracocentesispneumonectomyralesinterstitium pulmonary edemasubcutaneous emphysema

Kerely B linescardiomegaly neoplasmbenignmalignantcrepitantsitus inversustracheostomy

Abdomen: distentionflatulenceflank stripesmassarteriosclerosisfree airair fluid levelsanomalyfecal stasisperitonitisadhesionsvolvulusintussusceptionaerophagiaeructationvena cava filterpulmonary embolism

Single contrast colon: catharticpurgativeproctologyproctoscopycolonoscopySims positionguaiac testoccult bloodfamilialsepsisseptacemia

UGI: non per os (NPO)contraindicationfistulacollodial suspensionMIN/Vhematemesisretrogastric spacemotility seriesenteroclysisintubationvalsalva maneuverrefluxtrendelenburg positionasymptomaticMenkel’s diverticulum

Air contrast colon: stenosed (stenosis)adenomasessilevillouspedunculatedcarcinomacytologicdifferentiatedmetastasisenteritisinflammatory bowel diseasecolitis

Quiz Questions

Name the 9 regionsof the abdomenand pelvis

2

1 4

3

5

7

8

6 9

What can be visualized

10. Spleen 11. Gallbladder12. Adrenal glands13. Stomach 14. Veins15. kidneys16. Colon (gas)17. bladder18. Pancreas19. Ureters Liver Y N NSm. Bowel Y Y N

Y ( if needed to see) or N

Gas? Urine?

What is normally visible

10. Spleen Y N N

11. Gallbladder N N N

12. Adrenal glands N N N

13. Stomach Y Y N

14. Veins N N N

15. kidneys Y N N

16. Colon (gas) Y Y N

17. bladder Y N Y

18. Pancreas N N N

19. Ureters N N N

Y ( if needed to see) or N

Gas? Urine?

Abdomen Positioning

20. What anatomical landmark is used to center (longitudinally) a KUB film? And to what part of film (top, center, bottom)

22-24. What 3 conditions can be demonstrated on the upright abdomen, in addition to what can be demonstrated on the supine KUB? (Two are shown here).

21. What anatomical landmark is used to center (longitudinally) an upright of the abdomen? And to what part of film (top, center, bottom)

Abdomen Positioning

20. What anatomical landmark is used to center (longitudinally) a KUB film? And to what part of

film (top, center, bottom) Iliac Crest, center

22-24. What 3 conditions can be demonstrated on the upright abdomen, in addition to what can be demonstrated on the supine KUB? (Two are shown here).

Air fluid levelsFree air in the abdomen (pneumoperitoneum)

Ptosis

21. What anatomical landmark is used to center (longitudinally) an upright of the abdomen? And to what part of film (top, center, bottom)

Axilla, top

Radiographic Anatomy of PA Chest

29

3127

25

2628

30

Radiographic Anatomy of PA Chest

29 Dome of the Rt hemidiaphragm

31 Lt costophrenic angle

27 Rt cardiophrenic angle

25 Lung markings

26 Rt. Pulmonary a.

28Aorticknob

30 Hilum of Lt lung

Define:

32. dyspnea33. angina34. sputum35. fibrile

Short answer:

36. How many ribs must be demonstrated on an inspiration PA CXR, and is it anterior or posterior ribs that are counted?

1

Define:

32. dyspnea – difficulty breathing 33. angina – chest pain (lt arm, neck) 34. sputum – pus/debris from deep in bronchial tree & alveoli 35. fibrile - fever

Short answer:

36. How many ribs must be demonstrated on an inspiration PA CXR, and is it anterior or posterior ribs that are counted? 10, posterior

Review of PA Film CritiqueOn all filmsPatient IDRt or Lt markerContrast & densityMotionArtifacts

PA chest criteria37. 38. 39. 40. 41.

Review of PA Film CritiqueOn all filmsPatient IDRt or Lt markerContrast & densityMotionArtifacts

PA chest criteria37. Clipping38. Inspiration39. Rotation40. Scapula free of lung fields41. Penetration of mediastinum

42. Name this position

43. If only a tube angle is used to accomplish it, what is the degree and direction of the CR?

45. What pathological condition would be demonstrated on the up side?

46. What pathological condition would be demonstrated on the down side?

44. Name this position

42. Name this position Apical lordotic (lordotic chest)

43. If only a tube angle is used to accomplish it, what is the degree and direction of the CR? 15-200 cephalad

45. What pathological condition would be demonstrated on the up side? Pneumothorax

46. What pathological condition would be demonstrated on the down side? Pleural effusion

44. Name this position (Rt) lateral decubitus

47. In which body habitus would the stomach lie in this extreme transverse position?

48.

50.

49.

47. In which body habitus would the stomach lie in this extreme transverse position? hypersthenic

48. 2nd or descendingpart of d.

50. Greater curvature of s.

49. pyloric antrum

51. What is the atomic number of barium?

52. True or false: Barium is Insoluble in water.

53. Is this film AP, PA, or RAO?

54. Is this film AP, PA, or RAO?

55. Is this film AP, PA, or RAO?

56. What is the range of obliquity for an RAO stomach?

57. What body habitus requires the steepest obliquity?

51. What is the atomic number of barium? 56.

52. True or false: Barium is Insoluble in water. True

53. AP

54. PA 55. RAO

56. What is the range of obliquity for an RAO stomach? 40-700

57. What body habitus requires the steepest obliquity? Hypersthenic

58. “Rule out MI” is sometimes given as the reason for an UGI. What is an MI?

59. What UGI projection best demonstrates the retrogastric space?

60. What is the range of obliquity for the LPO position of the stomach?

61. Name one reason that barium would be contraindicated for use in the GI tract.

62. The spot film shown here is generally taken as the film of what examination?

58. “Rule out MI” is sometimes given as the reason for an UGI. What is an MI? Myocardial infarction, or heat attack.

59. What UGI projection best demonstrates the retrogastric space? Rt lateral

60. What is the range of obliquity for the LPO position of teh stomach? 30-600

61. Name one reason that barium would be contraindicated for use in the GI tract. Perforated bowel, post surgical, or, obstruction

62. The spot film shown here is generally taken as the film of what examination? Small bowel series (SBS) Small bowel follow through (SBFT) Motility series

Radiographic Anatomy of the colon

65.

63.

67

68

64. The folds that create the characteristicappearance of the colon

66

Radiographic Anatomy of the colon

65. Cecum

63. Hepatic (Rt. colic) flexure

67. Descending c.

68. Rectum

64. Haustra (haustral folds, haustrations)

66. Terminal ileum

69. Other than laxative, what other name is given a medicinal preparation that stimulates the bowel to evacuate, and is so used for a bowel prep? (2 possibilities)

70. What is the name of the position used for enema tip insertion?

71. Is this position a steep RAO, LAO, RPO, or LPO?

72. Approximately how high above the table should be barium bag be hanging?

73. The terms septic and sepsis refer to: a. infection b. wall or division between parts c. toxic chemicals d. gangrene

69. Other than laxative, what other name is given a medicinal preparation that stimulates the bowel to evacuate, and is so used for a bowel prep? (2 possibilities) Cathartic or purgative

70. What is the name of the position used for enema tip insertion? Sims

71. Is this position a steep RAO, LAO, RPO, or LPO? LAO

72. Approximately how high above the table should be barium bag be hanging? 2 feet

73. The terms septic and sepsis refer to: a. infection b. wall or division between parts c. toxic chemicals d. gangrene

74. Septacemia

75. Ileostomy, jejunostomy, colostomy

76. Stoma

77. Resection

78. Anastomosis

79. Glucagon

74. Septacemia – Pathogenic microorganisms in the blood.

75. Ileostomy, jejunostomy, colostomy – ostomy = a surgically formed fistula, most commonly between intestine and the abdominal wall. (vs. otomy = surgical incision, vs. ectomy = removal)

76. Stoma – A mouth like artificial opening between two body cavities, or a passageway between a cavity and a body surface

77. Resection – partial excision of a part.

78. Anastomosis – natural or surgical connection between two tubular structures.

79. Glucagon – Hormone secreted by alpha cells of pancreas that stimulates liver to change stored glycogen to glucouse. Parentaral administration relaxes smooth muscles of alimentary tract.

Mass

Institutional colon

Pneumoperitoneum

Significant Pathologies or Pathologic Indicators of the abdomen

and their

Radiographic Appearances

Ascites

Ileus

Aneurysm

Pleural Effusion

Pneumothorax

Significant Pathologiesof the lungs, thorax, and mediastinal structures

and their

Radiographic Appearances

Pneumoconiosis

Atelectasis

Granulomatous disease

Congestive heart failure(CHF)

COPD (Bronchitis and emphysema)

Thoracic stomach

Diverticula

Ulcerations

Significant Pathologiesof the upper gastrointestinal tract

and their

Radiographic Appearances

Diverticulosis

Abdominal hernias

Tape worms

Significant Pathologiesof the colon

and their

Radiographic Appearances

Polyps

Colorectal Cancer

Chron’s disease

Intussusception

Institutional colon

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, 12:1 grid, 40” SID

Frontal

(2 x cm) + 35 =kVp @ 50 mAs

Abdomen/Pelvis

Lateral (4x frontal)

(AP + 10 kVp @ 100 mAs Oblique (AP + 40% - 60% of frontal technique

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, 40” SID

Maternal Abdomen

What is required in terms of kVp and mAs?

High kVp (110 or higher), low mAs.

On occasion a radiograph of the pregnant abdomen is ordered during labor, to checkfor a breech presentation.

Every radiology department should have at least one high speed film/screen system for this purpose.

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 400 RS film, 40” SID

Calculate a maternal abdomen technique for a 35 cm measurement

2. 40 mAs / 4 = 12.5 mAs (film speed)

3. 15% of 105 = 16.5 =

1. (2 x 35) + 35 = 105 kVp @ 50 mAs

Answer 121 kVp @ 6 mAs

Critique critera: For presentation, only gross anatomy need be visualized. Maternal abdomen films are rarelyrepeated.

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, medium speed screen, 72” SID

PA Chest: 2 x cm + 35 = kVp @ 5 mAsLat Chest: PA kVP + 10 @ mAs x 2

Chest radiography may be done screen or grid, dependant on department protocol and circumstance, e.g. surgical or portable.

When done screenAdvantage is: lower kVp = greater contrastDisadvantage is: lower kVp = less penetration

When done grid

Advantage is: high kVp = greater penetration Disadvantage is: high kVp = less contrast

What must be set to use AEC?

kVp1.2.3.4.5.

mA

Chambers

Back up time

+ or – density

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, medium speed screen, 72” SID

Compute a technique for a double contrast, and single contrastUGI for a 26 cm abdomen in an AP position, using 400 RS system

1. (2 x 26) + 35 = 87 kVP @ 50 mAs

2. 50 mAs / 4 (RS) = 87 kVp @ 12.5 mAs (Double contrast)

3. 87 + 13 = 100 kVp @ 6 mAs (Single Contrast)

Now put the patient in an RAO (single contrast)

Up AP technique by 40 – 60 % = 108 kVp at 6 mAs

Now put the patient in a right lateral (double contrast)

Up AP kVp by 10, double mAs = 97 kVp @ 25 mAs

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, 40” SID, 12:1 grid

Colon: Use computation for abdomen, except, kVp above 100 for barium

Problem: For a patient with an AP diameter of 25 cm at the level of the umbilicus, using a 400 RS screen/film combination, what techniques would be used for: AP Oblique Axial sigmoid views & Lateral rectum

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, 40” SID, 12:1 grid

89 kVp @50 (KUB technique)

Problem: For a patient with an AP diameter of 27 cm at the level of the umbilicus, using a 400 RS screen/film combination, what techniques would be used for: AP

89 kVp @12.5 (400 RS)

103 kVp @12.5 (15% rule to increase kVp)

Oblique

103 kVp @19 (50% increase taken in mAs) or 120 kVp @ 12.5 (50% increase taken in kVp)

Exposure Factors

From the “Rules of Thumb”

Based on: 3 phase, 100 RS film, 40” SID, 12:1 grid

Lateral rectum

103 kVp @ 12.5 50 (AP technique)118 kVp @ 25 mAs (2 x kVp and 2 x mAs) Note: for a KUB the kVp rule was increase by 10, but that was in the 70-80 kVp range to start with.

Problem: For a patient with an AP diameter of 27 cm at the level of the umbilicus, using a 400 RS screen/film combination, what techniques would be used for:

Axial sigmoid is same as oblique technique

103 kVp @19 (50% increase taken in mAs) or 120 kVp @ 12.5 (50% increase taken in kVp)

Exposure Factors

From the “Rules of Thumb”

AEC is sometimes used for barium studies, and is usually successful.

When using AEC for barium studies the centering of thechamber or chambers over solid barium or solid air will lead tofilms that are too light or too dark.

Using multiple results in an average of the densities sampled, andlessens the possibility of error.

Plus and minus density may be needed for some views