CHAPTER 20 Radiology and Diagnostic Imaging Radiology and

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CHAPTER 20 Radiology and Diagnostic Imaging

CHAPTER 20 Radiology and Diagnostic Imaging

Radiology and Diagnostic Imaging Overview • X-rays – High-energy electromagnetic waves – Travel in

Radiology and Diagnostic Imaging Overview • X-rays – High-energy electromagnetic waves – Travel in straight lines – Shorter wave length than visible light – Able to penetrate solid materials of varying densities – Capable of exposing a photographic plate (X-ray film) • Much the same way as a camera exposes film 2

Radiology and Diagnostic Imaging Overview • X-rays – Used to visualize internal organs and

Radiology and Diagnostic Imaging Overview • X-rays – Used to visualize internal organs and structures of body – Provide valuable means for verifying presence of illness or disease • Radiology – Study of the diagnostic and therapeutic uses of X-rays 3

PROCEDURES AND TECHNIQUES Radiology and Diagnostic Imaging

PROCEDURES AND TECHNIQUES Radiology and Diagnostic Imaging

Angiocardiography (Cardiac Catheterization) • Pronounced – (an-jee-oh-kar-dee-OG-rah-fee) – (CAR-dee-ak kath-eh-ter-ih-ZAY-shun) • Defined – Specialized

Angiocardiography (Cardiac Catheterization) • Pronounced – (an-jee-oh-kar-dee-OG-rah-fee) – (CAR-dee-ak kath-eh-ter-ih-ZAY-shun) • Defined – Specialized diagnostic procedure in which a catheter is introduced into a large vein or artery – Usually of an arm or a leg, and is then threaded through circulatory system to the heart 5

Angiography • Pronounced – (an-jee-OG-rah-fee) • Defined – Series of X-ray films allowing visualization

Angiography • Pronounced – (an-jee-OG-rah-fee) • Defined – Series of X-ray films allowing visualization of internal structures after the introduction of a radiopaque substance 6

Cerebral Angiography • Pronounced – (seh-REE-bral an-jee-OG-rah-fee) – (SER-eh-bral an-jee-OG-rah-fee) • Defined – Injection

Cerebral Angiography • Pronounced – (seh-REE-bral an-jee-OG-rah-fee) – (SER-eh-bral an-jee-OG-rah-fee) • Defined – Injection of a radiopaque contrast medium into an arterial blood vessel (carotid, femoral, or brachial) to make visualization of the cerebral vascular system via X-ray possible 7

Renal Angiography • Pronounced – (REE-nal an-jee-OG-rah-fee) • Defined – X-ray visualization of internal

Renal Angiography • Pronounced – (REE-nal an-jee-OG-rah-fee) • Defined – X-ray visualization of internal anatomy of the renal blood vessels (blood vessels of the kidney) after injection of a contrast medium 8

Arteriography • Pronounced – (ar-tee-ree-OG-rah-fee) • Defined – X-ray visualization of arteries following the

Arteriography • Pronounced – (ar-tee-ree-OG-rah-fee) • Defined – X-ray visualization of arteries following the introduction of a radiopaque contrast medium into the bloodstream through a specific vessel by way of a catheter 9

Arthrography • Pronounced – (ar-THROG-rah-fee) • Defined – Process of taking X-rays of the

Arthrography • Pronounced – (ar-THROG-rah-fee) • Defined – Process of taking X-rays of the inside of a joint, after a contrast medium has been injected into the joint • Contrast medium makes the inside of the joint visible 10

Barium Enema (BE) • Pronounced – (BAH-ree-um EN-eh-mah) • Defined – Infusion of a

Barium Enema (BE) • Pronounced – (BAH-ree-um EN-eh-mah) • Defined – Infusion of a radiopaque contrast medium, barium sulfate, into the rectum – Contrast medium is retained in lower intestinal tract while X-ray films are obtained of the lower GI tract 11

Barium Swallow (Upper GI Series) • Pronounced – (BAH-ree-um SWALL-oh) • Defined – Oral

Barium Swallow (Upper GI Series) • Pronounced – (BAH-ree-um SWALL-oh) • Defined – Oral administration of a radiopaque contrast medium, barium sulfate, which flows into the esophagus as the person swallows • X-rays are taken as barium sulfate flows into the upper GI tract 12

Bronchography • Pronounced – (brong-KOG-rah-fee) • Defined – Bronchial examination via X-ray following the

Bronchography • Pronounced – (brong-KOG-rah-fee) • Defined – Bronchial examination via X-ray following the coating of the bronchi with a radiopaque substance 13

Cholangiography (Intravenous) • Pronounced – (koh-lan-jee-OG-rah-fee) – (in-trah-VEE-nus) • Defined – Visualizing and outlining

Cholangiography (Intravenous) • Pronounced – (koh-lan-jee-OG-rah-fee) – (in-trah-VEE-nus) • Defined – Visualizing and outlining of the major bile ducts following an intravenous injection of a contrast medium 14

Cholangiography (Percutaneous Transhepatic) • Pronounced – (koh-lan-jee-OG-rah-fee) – (per-kyoo-TAY-nee-us trans-heh-PAT-ik) • Defined – Examination

Cholangiography (Percutaneous Transhepatic) • Pronounced – (koh-lan-jee-OG-rah-fee) – (per-kyoo-TAY-nee-us trans-heh-PAT-ik) • Defined – Examination of bile duct structure using a needle to pass directly into an intrahepatic bile duct to inject a contrast medium • Also known as PTC or PTHC 15

Cholangiopancreatography (Endoscopic Retrograde) • Pronounced – (koh-lan-jee-oh-pan-kree-ah-TOG-rah-fee) – (en-doh-SKOP-ic RET-roh-grayd) • Defined – Procedure

Cholangiopancreatography (Endoscopic Retrograde) • Pronounced – (koh-lan-jee-oh-pan-kree-ah-TOG-rah-fee) – (en-doh-SKOP-ic RET-roh-grayd) • Defined – Procedure that examines the size of and the filling of the pancreatic and biliary ducts through direct radiographic visualization with a fiberoptic endoscope 16

Cholecystography (Oral) • Pronounced – (koh-lee-sis-TOG-rah-fee) • Defined – Visualization of the gallbladder through

Cholecystography (Oral) • Pronounced – (koh-lee-sis-TOG-rah-fee) • Defined – Visualization of the gallbladder through X-ray following the oral ingestion of pills containing a radiopaque iodinated dye 17

Cineradiography • Pronounced – (sin-eh-ray-dee-OG-rah-fee) • Defined – Diagnostic technique combining the techniques of

Cineradiography • Pronounced – (sin-eh-ray-dee-OG-rah-fee) • Defined – Diagnostic technique combining the techniques of fluoroscopy, radiography, and cinematography by filming the images that develop on a fluorescent screen with a movie camera 18

Computed Axial Tomography (CT, CAT) • Pronounced – (kom-PEW-ted AK-see-al toh-MOG-rahfee) • Defined –

Computed Axial Tomography (CT, CAT) • Pronounced – (kom-PEW-ted AK-see-al toh-MOG-rahfee) • Defined – Painless, noninvasive diagnostic X-ray procedure using ionizing radiation that produces a cross-sectional image of the body 19

Computed Axial Tomography 20

Computed Axial Tomography 20

Voiding Cystourethrography • Pronounced – (VOYD-ing sis-toh-yoo-ree-THROG-rahfee) • Defined – X-ray visualization of the

Voiding Cystourethrography • Pronounced – (VOYD-ing sis-toh-yoo-ree-THROG-rahfee) • Defined – X-ray visualization of the bladder and urethra during the voiding process, after the bladder has been filled with a contrast material 21

Digital Subtraction Angiography (DSA) • Pronounced – (DIJ-ih-tal sub-TRAK-shun an-jee-OG-rahfee) • Defined – X-ray

Digital Subtraction Angiography (DSA) • Pronounced – (DIJ-ih-tal sub-TRAK-shun an-jee-OG-rahfee) • Defined – X-ray images of blood vessels only, appearing without any background, due to the use of a computerized digital video subtraction process 22

Echocardiography • Pronounced – (ek-oh-kar-dee-OG-rah-fee) • Defined – Diagnostic procedure for studying the structure

Echocardiography • Pronounced – (ek-oh-kar-dee-OG-rah-fee) • Defined – Diagnostic procedure for studying the structure and motion of the heart via ultrasound • Useful in evaluating structural and functional changes in a variety of heart disorders 23

Fluoroscopy • Pronounced – (floor-or-OSS-koh-pee) • Defined – Radiological technique used to examine the

Fluoroscopy • Pronounced – (floor-or-OSS-koh-pee) • Defined – Radiological technique used to examine the function of an organ or a body part using a fluoroscope 24

Hysterosalpingography • Pronounced – (his-ter-oh-sal-ping-OG-rah-fee) • Defined – X-ray assessment of uterus and fallopian

Hysterosalpingography • Pronounced – (his-ter-oh-sal-ping-OG-rah-fee) • Defined – X-ray assessment of uterus and fallopian tubes by injecting a contrast material into these structures 25

Lymphangiography • Pronounced – (lim-fan-jee-OG-rah-fee) • Defined – X-ray assessment of lymphatic system following

Lymphangiography • Pronounced – (lim-fan-jee-OG-rah-fee) • Defined – X-ray assessment of lymphatic system following injection of a contrast medium into lymph vessels in the hand or foot 26

Magnetic Resonance Imaging (MRI) • Pronounced – (mag-NET-ik REZ-oh-nans IM-ij-ing) • Defined – Noninvasive

Magnetic Resonance Imaging (MRI) • Pronounced – (mag-NET-ik REZ-oh-nans IM-ij-ing) • Defined – Noninvasive scanning procedure that provides visualization of fluid, soft tissue, and bony structures without the use of radiation 27

Mammography • Pronounced – (mam-OG-rah-fee) • Defined – Process of taking X-rays of the

Mammography • Pronounced – (mam-OG-rah-fee) • Defined – Process of taking X-rays of the soft tissue of the breast to detect various benign and/or malignant growths before they can be felt 28

Myelography • Pronounced – (my-eh-LOG-rah-fee) • Defined – Introduction of contrast medium into the

Myelography • Pronounced – (my-eh-LOG-rah-fee) • Defined – Introduction of contrast medium into the lumbar subarachnoid space through a lumbar puncture to visualize the spinal cord and vertebral canal through X-ray examination 29

Positron Emission Tomography Scan (PET) • Pronounced – (POZ-ih-tron ee-MISH-un toh-MOG-rah-fee) • Defined –

Positron Emission Tomography Scan (PET) • Pronounced – (POZ-ih-tron ee-MISH-un toh-MOG-rah-fee) • Defined – Noninvasive diagnostic imaging method that demonstrates the biological function of the body before anatomical changes take place • Scan produces computerized radiographic images of the body structures when radioactive substances are administered to the patient – Substances are inhaled or injected 30

Pyelography (Intravenous) (IVP) • Pronounced – (pye-eh-LOG-rah-fee) – (in-trah-VEE-nus) • Defined – Radiographic procedure

Pyelography (Intravenous) (IVP) • Pronounced – (pye-eh-LOG-rah-fee) – (in-trah-VEE-nus) • Defined – Radiographic procedure that provides visualization of the entire urinary tract: kidneys, ureters, bladder, and urethra • Also known as intravenous pyelogram or excretory urogram 31

Radiation Therapy • Pronounced – (ray-dee-AY-shun THAIR-ah-pee) • Defined – Delivery of ionizing radiation

Radiation Therapy • Pronounced – (ray-dee-AY-shun THAIR-ah-pee) • Defined – Delivery of ionizing radiation to accomplish one or more of the following: • • • Destruction of tumor cells Reduction of tumor size Decrease in pain Relief of obstruction To slow or stop the spread of cancer cells 32

Radiation Therapy • Radiation therapy – Destroys rapidly multiplying cells regardless of whether they

Radiation Therapy • Radiation therapy – Destroys rapidly multiplying cells regardless of whether they are cancerous – Goal is to reach maximum tumor control with no, or minimal, normal tissue damage – May be delivered by teletherapy (external) – May be delivered by brachytherapy (internal) 33

Radioactive Iodine Uptake • Pronounced – (ray-dee-oh-AK-tiv EYE-oh-dine UP-tayk) • Defined – Examination that

Radioactive Iodine Uptake • Pronounced – (ray-dee-oh-AK-tiv EYE-oh-dine UP-tayk) • Defined – Examination that determines the position, size, shape, and physiological function of the thyroid gland through the use of radionuclear scanning • Image of the thyroid is recorded and visualized after a radioactive substance is given 34

Scanning (Bone, Brain, Liver, Lungs) • Pronounced – (SCAN-ing) • Defined – Scanning is

Scanning (Bone, Brain, Liver, Lungs) • Pronounced – (SCAN-ing) • Defined – Scanning is the process of recording emission of radioactive waves, using a gamma camera (scanner) • After an intravenous injection of a radionuclide material into the particular part of the body being studied 35

Scanning (Bone, Brain, Liver, Lungs) • Defined – Image of the area being studied

Scanning (Bone, Brain, Liver, Lungs) • Defined – Image of the area being studied is displayed by recording concentration or collection of a radioactive substance specifically drawn to that area 36

Scanning • Bone – Involves intravenous injection of a radionuclide material absorbed by bone

Scanning • Bone – Involves intravenous injection of a radionuclide material absorbed by bone tissue • Used to detect spread of cancer to the bones, osteomyelitis, and other destructive changes in the bones 37

Scanning • Brain – Nuclear scanning of cranial contents two hours after an intravenous

Scanning • Brain – Nuclear scanning of cranial contents two hours after an intravenous injection of radioisotopes • Useful in diagnosing abnormal findings such as an acute cerebral infarction, cerebral neoplasm, cerebral hemorrhage, brain abscess, aneurysms, cerebral thrombosis, hematomas, hydrocephalus, cancer metastasis to the brain, and bleeds 38

Scanning • Liver – Noninvasive scanning technique that enables the visualization of the shape,

Scanning • Liver – Noninvasive scanning technique that enables the visualization of the shape, size, and consistency of the liver after the IV injection of a radioactive compound • Useful in detecting cysts, abscesses, tumors, granulomas, or diffuse infiltrative processes affecting the liver 39

Scanning • Lung – Visual imaging of the distribution of ventilation or blood flow

Scanning • Lung – Visual imaging of the distribution of ventilation or blood flow in the lungs by scanning the lungs after the patient has been injected with or has inhaled radioactive material 40

Scanning • Spleen – Noninvasive scanning technique that enables the visualization of the shape,

Scanning • Spleen – Noninvasive scanning technique that enables the visualization of the shape, size, and consistency of the spleen after injection of radioactive red blood cells • Useful in detecting damage, tumors, and other problems 41

Single-Photon Emission Computed Tomography (SPECT) • Pronounced – (single FOH-ton ee-MISH-un kom-PEW-ted toh-MOG-rah-fee) •

Single-Photon Emission Computed Tomography (SPECT) • Pronounced – (single FOH-ton ee-MISH-un kom-PEW-ted toh-MOG-rah-fee) • Defined – Nuclear imaging procedure that shows how blood flows to tissues and organs • Tracking of radioactive material allows physician to see perfusion of blood to tissues and organs 42

Small Bowel Follow-Through • Pronounced – (Small Bowel Follow-Through) • Defined – Oral administration

Small Bowel Follow-Through • Pronounced – (Small Bowel Follow-Through) • Defined – Oral administration of a radiopaque contrast medium, barium sulfate, which flows through the GI system • X-ray films are obtained at timed intervals to observe progression of barium through small intestines 43

Tomography • Pronounced – (toh-MOG-rah-fee) • Defined – X-ray technique used to construct a

Tomography • Pronounced – (toh-MOG-rah-fee) • Defined – X-ray technique used to construct a detailed cross-section, at a predetermined depth, of a tissue structure • Useful in identifying space-occupying lesions in the liver, brain, pancreas, and gallbladder 44

Ultrasonography (Ultrasound) • Pronounced – (ull-trah-son-OG-rah-fee) • Defined – Procedure in which sound waves

Ultrasonography (Ultrasound) • Pronounced – (ull-trah-son-OG-rah-fee) • Defined – Procedure in which sound waves are transmitted into body structures as a small transducer is passed over the patient’s skin • Sound waves are reflected back into the transducer and are interpreted by a computer that converts waves to a composite picture form 45

Ultrasonography • Abdominal ultrasound – Use of reflected sound waves to provide reliable visualization

Ultrasonography • Abdominal ultrasound – Use of reflected sound waves to provide reliable visualization of the liver, gallbladder, bile ducts, pancreas, kidneys, bladder, and ureters 46

Ultrasonography • Pelvic ultrasound – Noninvasive procedure that uses highfrequency sound waves to examine

Ultrasonography • Pelvic ultrasound – Noninvasive procedure that uses highfrequency sound waves to examine the abdomen and pelvis – Can be used to locate a pelvic mass, an ectopic pregnancy, or an intrauterine device, and to inspect and assess the uterus, ovaries, and fallopian tubes 47

Ultrasonography • Renal ultrasound – Noninvasive ultrasound of the kidneys that is useful in

Ultrasonography • Renal ultrasound – Noninvasive ultrasound of the kidneys that is useful in distinguishing between fluid-filled cysts and solid masses, detecting renal calculi, identifying obstructions, and evaluating transplanted kidneys • Thyroid Echogram (ultrasound) – Ultrasound examination important in distinguishing solid thyroid nodules from cystic nodules 48

Venography • Pronounced – (vee-NOG-rah-fee) • Defined – Technique used to prepare an X-ray

Venography • Pronounced – (vee-NOG-rah-fee) • Defined – Technique used to prepare an X-ray image of veins – Veins are injected with a radiopaque contrast medium – Phlebography 49

X-rays • Pronounced – (ECKS-rays) • Defined – Use of high-energy electromagnetic waves, passing

X-rays • Pronounced – (ECKS-rays) • Defined – Use of high-energy electromagnetic waves, passing through the body onto a photographic film, to produce a picture of the internal structures of the body for diagnosis and therapy 50

X-rays • Chest X-ray – Visualization of interior of chest – Provides diagnostic information

X-rays • Chest X-ray – Visualization of interior of chest – Provides diagnostic information about: • Tumors, inflammation, accumulation of fluid, accumulation of air, bone fractures, diaphragmatic hernia, size of heart, calcification, placement of centrally located intravenous access devices 51

X-rays • Chest X-ray views – Posteroanterior (PA) • X-rays pass through the posterior

X-rays • Chest X-ray views – Posteroanterior (PA) • X-rays pass through the posterior (back) to the anterior (front) – Lateral • X-rays pass through the person’s side – Oblique • X-rays are taken from different angles – Decubitus • X-rays are taken with person in recumbent lateral position – aids in localizing fluid 52