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RAD 100 CH 9 and 10

Chapter 9 and 10 Radiology

BE- Barium Enema radiographic examination of the colon (flouro exam) indicate tumors, obstructions, diverticula & inflammation ACBE: air introduced for double contrast study – better visualization of diverticula and polyps Failed colonoscopy
IVP (fluoroscopic) Intravenous pyelogram (IVP) AKA Intravenous urogram (IVU) (fluor exam) urinary system study Ionated contrast agent injected into the bloodstream through a vein in the arm Helps visualize stones in the urinary system and evaluated kidney functions
HSG (special study) Hysterosalpingogram: evaluation of uterus & fallopian tubes; oil-based iodinated contrast introduced & filmed with DF or spot films and overheads
Figure 9-3 A- Arteriogram (looks like stick person) B- Myelogram (white tube)
Figure 9-1 A- failure to remove patients jewelry B- Contrast medium provides contrast between and organ and surround tissue C- RAD prepares an injection of an ionated contrast agent
Conditions limiting use of barium as a contrast medium Contraindicated if surgery appears imminent or if perforated stomach/intestine is suspected – water-soluble iodinated contrast agent instead
ERCP (fluoroscopic) Endoscopic retrograde cholangiopancreatography o To dx anomalies in biliary system or pancreas o Contrast injected into common bile duct after located with fiberoptic scope passed down esophagus, thru stomach & into small intestine
Sialogram (special study) Study of salivary glands after injection of contrast; rad and/or fluoro
Arthrogram (special study) Evaluate joint spaces; knee & shoulder most common; iodinated contrast injected into joint filmed with DF or spot films following fluoro
Tomography (special study) Tomography: modality primarily used for urography, if at al
Esophogram (fluoroscopic) Requires patient to swallow Ba during fluoro, which is followed from mouth to stomach to visualize tumors, constrictions & spasms
Cystography (urinary study) Filling bladder with contrast then taking spot films & radiographs
Myelography (special study) Fluoro exam of the spinal cord (subarachnoid space) to remove CSF & inject iodinated contrast into back or neck; DF or spot films & overheads
Mammography (special study) Radiographic study of breast with compression to aid visualization
Panoramic tomography Used for radiographic studies of the skull and headwork (above neck) image of a curved body surface, such as the upper and lower jaws, on a single film.
Double-contrast study Adding a second element to first contrast, allows for better visualizations of abnormalities Air May be used w/ barium or iodine agents
General types of contrast media used iodine-based barium-based air
Medium of choice for chest radiography Air Easily penetrated by x-rays Provides contrast between lung tissues, vessel markings & air sacs
Reasons for performing extremity studies To evaluate bone fractures (fx), dislocation, arthritis, osteoporosis, tumors, developmental conditions, & other pathologies > Require great care in handling 2nd most radiographed area of body
Reasons for performing headwork studies For evaluation of possible fractures, locate foreign bodies or to examine abnormalities
Medium of choice for GI studies & why Ba (barium sulfate) to evaluate for hiatal hernias & peptic ulcers from stomach to the pyloric sphincter Allergic reactions almost nonexistent
Reasons for performing abdominal studies To evaluate the presence of foreign masses, calcifications, distribution of air in intestines, bony & soft tissue damage, and size, shape & location of major organs: liver, kidneys, spleen For children, fb ingestion (coins; marbles)
Studies used to supplement or replace BEs Virtual Colonoscopy and Colonoscopy with endoscope
Skills required for patient preparation Proper examination of patient is responsibility of radiographer,Checking for unwanted objects should be verbal, visual, and tactile
Common patient preparation mistakes Forgetting to remove necklace in chest x-ray
Reasons for performing thoracic cavity studies evaluate fluid in lungs, over-expansion, collapsed lungs, tumors, cardiomegaly, other heart/lung abnormalities (pneumonia, CHF), and fxs of ribs, sternum and SCJs
The rationale for using nonionic contrast media reduces potential side effects
The most commonly radiographed area of the body Thoracic Cavity – chest bones & tissues
Who carries patient preparation Preparation of the patient for radiographic exam is responsibility of the physician who ordered the exam, nurse, and radiographer
External preparation Must be done with EVERY examination,Removing any material that is covering the body area through which x-rays may pass,Clothing; buttons/zippers; jewelry: necklaces; hair; dentures; piercings; tattoos,Verbal, visual and tactile checks
Internal preparation To be done with some (contrast) exams, Preparation is performed on nursing unit (IP) or at home (OP),Cleansing enemas; diet instruction; suction
Venogram to evaluate the veins after contrast injection; very similar to arteriogram but more rare
Arteriogram to visualize the arteries; iodinated contrast is injected to show blood flow & to evaluate shape/condition of arteries. Requires use of DF, auto-injectors & sterile field
Excretory urography, IVP and IVU Excretory urography is also called intravenous pyelogram (IVP) AKA Intravenous urogram (IVU)
Density Measurement of darkness on radiograph (over expose: black, under: white), Affect quality of radiograph, Most important, detail & contrast are nonexistent without it Presents a difference in the degree of absorption of radiation
Contrast Differences in density makes differentiation of structures possible Can not have without density
Fog and its effects Unwanted density on IR- caused from scatter Increases density/volume of tissue, Detracts from quality of image, overall grayness obliterates small structures
Kilovoltage (kV, kVp) Unit of electrical potential,affects amount of x-ray produced; determines energy of x-rays > penetrability,greater the power, greater the remnant radiation reaching IR, Higher kVP- great energy of radiation, more x-rays traverse patient and strike IR
Advantages of using cones/collimators Beam Limiting Devices, Attached to x-ray tube to reduce exposure field size- improve image, Decreases amount of radiation, Decreases scatter radiation, Decreases fog
Factors that affect the visibility of detail Fog- decreases contrast, Patient Motion- (greatest factor) blurring image
Factors that can increase radiographic density Atomic number tissue density (air, fat, muscle, bone, metal)
Relationship between kVp, tissue densities and Z#s, penetrability, and radiographic contrast, including scales of contrast: The more dense a tissue (higher the z#), more kVp (energy) will be needed to penetrate the area.  Short Scale Contract • Low kVp • High Contrast (Black and White)  Long Scale Contract • High kVp • Low Contrast (Black, White, Shades of Grey
The inverse square law and how to apply it to changes in distance/intensity I=Intensity, D=Density I1 (D2)2 I2 (D1)2 100 = (72)2 X (36)2 100 = 5184 Cross multiply, 5184x=12960 divide, x=25mR X 1296
Determine how changes in mAs effect the film and calculate for over- or underexposure Over exposure is black- place on film where many photons hit screen (too much time) o Under exposure is white- place on film where no photons hit screen (not enough time)  Losing contrast with under or over exposure.
Relationship between magnification and radiographic detail o more magnification of object, less radiographic detail o farther OID, greater magnification o increase SID, decrease magnification and increase detail
Relationship between mA/mAs and radiographic density o The denser the object, the more mA/mAs needed to show areas of darkness if the exposure to a radiographic film is increased, the radiographic film density will also increase
Primary determinant of object shape on a radiograph Beam Alignment  alignment of the object in relation to the x-ray tube and IR will determine the shape  objects placed at right angle of direction of the beam and parallel, can be seen in true shape
Factors that can increase radiographic contrast Greater the absorption differences, the greater the contrast Density of bone and density of air Age State of health Body habitus Pathology Thickness of part Contrast media
Relationship between mA and mAs, & exposure time and mAs (be able to calculate each factor to solve numerical problems) Seconds: change in exposure time is directly proportional to radiation exposure or output mAs - mA × sec 20 mAs - 200 mA × 0.1 sec 20 mAs - 100 mA × 0.2 sec
Film Screen Receptor Emulsion on both sides, silver bromide in gelatin Sandwiched between 2 intensifying screens Intensifying screens fluoresce w/ x-ray decrease patient dose 95% of image created from light of intensifying screens processed in chemicals to manifest image
Computed Radiography Latent image on phosphor plate (PSP) X-rays strike plate and e trapped in high energy state, Latent image in grains of phosphor, Laser light used to release synergy, Light signal is amplified and digitized, Manifest image
OID object to image receptor distance, increase OID=increase magnification, increase distortion- decreases detail
SID source to image receptor distance reduce magnification= need to increase SID, limited to usually 48” (40′′) and 72′′ If increased OID, need to increase SID to decrease magnification
Image (radiographic) vs. subject contrast Greater absorption differences create great contrast- resulting in a better image (Bone and Air), Little absorption differences create low contrast (Tissues (anatomic part with little difference in z#))
Quantitative mAs used to express quantity of radiation milliamperage- greater=more radiation, less=less radiation time- greater time= greater amount, less time= less amount
Qualitative kilovoltage, great the energy the great the ability to penetrate object and reach IR, creating a better image.
Exposure factors that affect density Kilovoltage: ENERGY, Milliamperage: AMOUNT, Time: LONGER/SHORTER, Distance: DIVERGE, Film (speed): some emulsions respond more readily than others to light/x-rays; generally, the thicker the emulsion the faster the film
The four radiographic densities inherent in the body Gas or Air (least dense) Fat, Muscle, Bone (most dense), Metal,
Relationship between intensifying screens and radiographic density if the exposure to a radiographic film is increased, the radiographic film density will also increase
Created by: juaire30