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advan im Bedle t1

What is a gold standard? a test that reflects the closest one can come to an absolute dx of a condition (ex: biopsy, autopsy, surgery/pathology)
Why aren't gold standards performed as screening tools? increased risk to the pts health, may require that the pt is dead, and very expensive to perform
Utilization of a imaging procedure is based upon what four factors? sensitivity, specificity, invasiveness, and cost.
What represents the probbaility that a pt who actually has a pathology will be dxed as having that pathology that the test is intended to reveal? senisitivity
Represents the probability that a pat actually not having the pathology will be dxed as such? specificity
Is bone scintigraphy sensitive and specific? no, just sensitive.
start sensitive as a ___ test, progress to specific for a ____ testing sensitive for screening, and specific for confirmatory.
what are four dif types of screening tests? hx taking, phys exam, plain film, and bone scan.
how can intermediate tests be used as a gold standard? when comparing it to a screening test (MRI or CT compared with plain film)
what are pros to plain film? readily available, decent specificity***, cost effective (50-200), min pt risk.
what are cons of plain film? poor sensitivity****, over-reliance, dr. financial incentive, radiation exposure.
what % of significant lesions are found thru hx and phys exam alone before imaging? 90%
what % of chiros have an xray in the office? 85%
what % range of new pts are xrayed at a chiro office? 73-96%, avg 3.4 views
VINDICATES? vascular, infection/inflam, neoplasia, degenerative, ingested/iatrogenic, congenital, autoimmune, trauma, endocrine/metabolic, syche
what are diagnostic radiology that can be performed on the chest? CXR, tomography, ct, radionuclide scanning, angiograpghy, bronchography
what is CXR an important screening tool for> pulm dz, mediastinal dz, disorders of the bony thorax
Chest abnormalities may mimic what? musculoskel conditions of the tspine, shoulder, or neck. (many lung abnormalities are discovered on these views)
CXR is chiro for? followed up to t-spine exam, pts with hx cancer, pre-employment exam, high risk lung carcionma, t-spine trauma, rib fx, or review from hospital.
what is the minimal diagnostic series of the chest? PA chest, and lateral chest.
what are supplemental views of the chest? apical lordotic, expiratory, lateral decubitus, ap t-spine
PA Chest: ___FFD, ____Cassette 72 FFD with chest cassette - PA & 72 to min heart shadow
breathing instructions for chest xray? taken on 2nd deep inspiration
where should the diaphragm be on xray? at the right 10th posterior rib
what kvp is used for chest and why? high (110-120) for long scale of contrast, and should see the IVD of t6,
What are the 4 criteria to a diagnostic CXR? 1. Full inspiration - see 10th rt rib posteriorly, 2. exposure - just able to see the T6 IVD, 3. Top margin: lung apices, 4. bottom/lat margin: see the lat costophrenic angles
lateral chest: ___ FFD, ____cassette, breathing instructions? what side closest to flim and why? why high kvp? 72 FFD, chest cassette, taken on 2nd deep inspiration, taken with left side closest to film to decrease heart magnification, and high kvp for soft tissue visualization
Apical Lordotic: tube tilt// or what else can be done? tube tilt is 15-30 degrees, or pt walks ft out from bucky to increase lordosis
why apical lordotic? see lung apex free of clavicular superimpositon to eval for apical lung tumoors and scarring in TB. Also to eval RML and lungula.
how is expiratory film set up? same as PA chest, only with the pt in total exhalation
why expiratory fim? eval trapped air in lungs (COPD, inhaled objects), used to eval pneumothorax.
Abdominal Plain film is 1st line diagnostic for the eval of? abdominal pain, abdominal trauma, abdominal distension, nausea/vomiting, diarrhea, constipation.
Abd conditions possible to visualize perforated viscus, interstinal obstruction, abd or gallstones ileus, organomegaly (liver and spleen), AAA, abdominal calcifications.
Limitations of plain film abdomen GI BLeed, hepatobiliary dz, acute cholecystitis, hepatitis, liver masses, acute pancreatitis, ulcers, pylenephritis.
What is the standard abdominal plain film? AP Recumbent (AKA KUB - kidneys/ureter/bladder)
AP recumbent extends from where to where? with what kvp? extends from diaphragm to pubic symph, generally around 80kvp for good constrast
What is AP upright abdomen good for evaluating? bowel gas patterns
What can be visualized in abd from PA chest? subphrenic gas
What can be visualized abd wise in lateral decubitis free intraperitoneal gas
What are three follow ups for abdomenal studies? diagnostic ultrasound, mri, ct
diagnostic ultrasound abdomen is good for what? good for organs and vascular (doppler), non-invasive, no radiation exposure, live time imaging.
What is CT of abdomen better for than US? better for calcifications
CT of abdomen gives ___ imaging of the entire abdomen faster imaging
Is acute AAA seen with MR Angiogram of abdomen? no
3 types of calcifications are? normal physiologic, dystropic, metastatic
normal physiologic calcifications consist of? thyroid cartilage, costal cartilage
what is dystrophic calcifications? calcifications which occur in diseased tissues. Stone formation is an exampple
what is metastatic calcifications? calcification of normal tissue, usually d/t hypercalcemi state (hyperparathyroid, lytic mets, multiple myeloma)
What are 4 examples of dystrophic calcifications from bone and joint? myositis ossificans, scleroderma, SLE, dermatomyositis
What 3 things are dystrophic calcifications classified according to? 1. morphologic features (what is looks like - shape, border sharpeness, marginal continuity, internal architecture) 2. location 3. mobility
Conduit Wall calcification shape border margin and matrix shape - tubular profile, ring like en face. border - possibly indistinct, margin - discontinuous. matrix - none.
mass like calcification shape border margin and matrix shape - variable. border - irreg, can resemble cyst. margin - interrupted. matrix - extensive internal calcification
cystic calcification shape, border, margin, matrix shape - round or oval, border - curvilear or round, margin - rim calcification can be irregular, matrix - can simulate internal, but not true interna calcification
concretion calcification, shape, border, margin, matrix shape - varied - round, oval, star shaped. border - sharp, clearly defined. margin - continuous, matrix - varied - dense, laminated, central lucency
Conduit wall calcifications are confined to only what? the tubular walls
That calcifcation of conduit walls are not ____ homogenous
what is the MC site of conduit wall calcifications? walls of arteries, where you may see interrupted but basically linear calcifications which may outline the vessel's branching patterns
where is calcification of the abd aorta mc? belwo the renal arteries, and may extend into both common iliac arteries
how is the distribution of calcification of the abd aorta> irregular and patchy, which corresponds to plaques
are abd aorta calc a contraindication to manipulation? no
what type of calcification is abd aortic aneurysm? cystic calcification
what causes aaa? atherosclerosis, collagen dz
95% AAA occur in pts between what ages? and what sex dominance? 60-80 yrs, Males 4:1
what size AAA should you not adjust? >3.8 cm
3cm-3.5 cm Abd aorta dilation
over 3.5 cm abd aorta aneurysm
4.5cm-6cm ab aorta surgical consultation
over 7 cm ab aorta? immediate consulation
plain films and AAA only give estimate sizes
abdominal aneurysm are considered ____ lesions unstable
what is the 2nd mc site for abd arterial calcification? iliac arteries
can iliac arteries undergo aneurysmal changes? yes, second only to the abdominal aorta
what is vas deferens calcification associated with? diabetes, rarely secondary to infection
what shape does vas deferns calc take on? v- shaped, usually bilateral and symmetic
what does the vas deferns calc parallel? pubic rami
what is the most diverse presentation of abdominal calcification? solid mass
how are the borders of solid mass calcifications? irregular and complex internal architecture
where do solid mass califications occur in abd? anywhere, central or peripheral adjactent to within organs
DDX for solid mass calcification? calcified mesenteric lymph nodes, leiomyoma, dermoid cyst (teratoma), injection granuloma
what are the mc causes of abd calcified mesenteric lymph nodes? TB and histoplasmosis
calcified mesenteric lymph nodes occur along where? broad arch from the LUQ to the RLQ within the small bowel mesentery, and can be multiple and varied sizes
Where do leiomyomas occur? anywhere, but usually uterus
what is a leiomyoma? smooth mm benign tumor
what type of calcification do leiomyomas have? a whorled type of a calcification or flocculation - may demonstrate a prominent bordering rim
What is a dermoid cyst? teratoma, contains tissue from all 3 dermal layers, may contain teeth hair and fat.
are dermoid cysts premalignant? yes although only 1% go on to degrade into squamous cell carcioma
what is injection granuloma? result from subcutaneous fat necrosis secondary to intramm injection of pharmaceuticals.
where are injection granulomas seen? soft tissues around the hip (glut med)
how are injection granulomas visulaized on xray? as solitary or multiple small calcific spheres
What is a cyst wall calcification? calcium deposition within the wall of an abnormal fluid-filled structure (AAA ex)
DDX cysts-wall calcification Hydatid cyst, PORCELAIN GALLBLADD, hemorrhagic cysts, hematoma (posttraumatic), arteria aneurysms
arterial aneurysms begin with a _____ calcification, then becomes ___ when aneurysmal conduit wall calcification then becomes cystic
What is echinococcal cyst? splenic cyst caused by echinococcus (hydatid cyst dz) 2/3 splenic cysts
are echinococcal cysts common in us? no
what does echinococcal cyst contain? tape worm scolex. Humans get it by ingestion.
Where do hydatid cysts form? solid organs, liver spleen, lung, brain - may have daughter cyst.
what age range and sex is porcelain gallbladder common in? Females 38-70
What % go on to develop gallbladder carcinoma from porcelain? 10-20%. therefore prophylactically removed, b/c poor prognosiss and aggressive tumor
what are concretions aka? stone or calculus
what are concretions? calcified mass that forms in a tubular or hollow structure (lumen of vessel, hollow viscus)
what are radiographic apperances of concretions? sharp, have clearly definied external margins, almost always continuous
what is the internal archtecture of concretions? may have concentric laminations, may contain slighlty eccentric area of lucency, may be homogenously dense.
What is an appendicolith? concreation found in the appendix (RLQ)
Appenidcolith plus abdominal pain? 90% probability of acute appendicitus
What % of gallstones calcify? 10-20% - must be to show up on xray
Most frequent pt with cholelithiasis? fat, females, forty, flatulent
What may multiple gallstones look like? bag of diamonds appearance
mercedes benz sign seen with? gallstones
Pancreatic calculi are most commonly assoicated with what? chronic pancreatits secondary to alcoholism
What are pancreatic calculi caused by? long standing ductal obstruction and inflammation
what are pancreatic calculi visualized on xray? multiple, tiny, dense, discrete opacities that cross the midline at l1-l2. DDX with radiopaque gastric contents
what is mc calcification of the pelvis? phleboliths
What is a phleboliths? represents a calcified thrombus within a vein.
what is the interior of a phlebolith like? concentric or slightly eccentric lucency
What are prostatic calcuil seen as? multiple concretions of various sizes clustered behind the pubic symphysis in males.
what is the cause of prostatic calculi? prior prostatitis
What is the cause of urinary stones? caused by chornic low-level dehydrations (renal stasis) or infection
urinary stones are MC where? southeast and southwest US
urinary stones are asymptomatic until when? until they cause obstruction
what are the mc urinary stones made of? calc phosphate, calc oxalate, and magnesium ammonium phosphate (struvite)
about ___% of upper tract calcuili contain enough calcium to be visualized on plain films 90%
what is a staghorn calculus? a large stone that occupies the renal collecting system forming a "cast" of the major calyces and renal pelvis
what are staghorn calculus made of> struvite
what can staghorn calculus cause? chronic hydronephrosis which can lead to renal failure
where do kidney stones tend to lodge? ureter-pelvic junc, iliac crests, and ureter-vesicle juction
urinary stones ddx?? phleboliths
Phlebolith vs kidney stone phleboliths are ovoid with a central lucency and located below the ischial spines, and most calculi are slightly irregular, uniformly dense and located above the ischial spines
what is hydronephrosis? dilation of the renal collecting system
what is hydronephrosis mc due to? obstruction by a ureteral calculus byt may also be caused by a renal mass
a stone in the ureter causes what? unilateral hydronephrosis
a stone in the bladder or urethra may cause what? bilateral hydronephrosis
what is the mc tx method or urinary calculi? extracorpal lithotripsy. pt placed in pool of water, lithotripser is asimed at the stone, prodcues schok wave, stones turned into sand, pt strains n the urine to collect the pulverized stone.
What causes bladder stones? obstruction and infection, may be a migrant renal stone.
what % of bladder stones are seen on xray? 50%, most are smooth and rounded
what is a jackstone stone? bladder stone that is stellate with spiculations radiating in all directions from the center
why are single contrast studies performed? to visualize the morphology of the bowel which assesses for outpouchng of the bowel, and indentations of the bowel
what is double contrast study for? visulazing the mucosal pattern
what are the 5 basic pathologic alterations seen on a contrast study? 1.polypod lesions 2. mucosal masses, 3. ulceration 4. diverticula 5. extrinsic compression
Polypod lesions appear as? small, rounded filing defects in the lumen. They may be broad based(sessile) or on a stalk (pedunculated)
muscosal masses, - begin as ____. there is an abrupt change of the muscosa from ___ to ____. Furhter growth will produce encasement as the tumor grows completely around the lumen --- ___ apperance begin as small polyps, change from normal to tumor.... apple core appearance
how does ulceration show on barium study? seen as a collection of barium found outside the normal lumen
what is Hamptons line? a smooth collar of inflamed mucosa is present between the lumen and the crater. Not cancerous
Diverticula benign out-pouching of the wall of the GI tract, may be small (colon), or large (esophagus)
Extrinsic compression appears as? a smooth indentation of the bowel wall with gradually tapering margins
zenkers diverticula, what and cause outpouching of the mm layer of the esophagus caused b abnormal pressure iwthin the esophageal lumen
location of zenkers diverticula? posterior pharynx @ the cricopharyngeous mm. - Killiams dehiscence, may be seen on plain film radiograpghs just anterior to the c6/7 level
pros to MRI excellent tissue contrast, high resolution imaging, imaging in any plane, lack of ionizing radiation, relatively noninvase, can add contrast for more info
cons to mri availability in us/can, implanted metal can have an affect, claustrophobia, obese ppl, contrast rxns, expsense (500-4000)
mri is used for? better visualization of patho, determining the extent of the patho, surgical planning, prognosis
absolute contraindications for mri? pacemaker, metallic foreign body in eye, cochlear implants, ferromagnetic surgical clips
relative contraindications for mri metallic devices in the area of interest that severely alter the resolution of the scan, prego (must get informed consent - no evidence of fetal effect), severe claustraphobia, morbid obese
how does ct generate an image? by rotating a thin beam of xrays around an axial plane of the body
pros to ct very available, high resolution of minute structures, useful for MRI contraindicated pts, can add contrast for more info
cons of ct very high dose, has demonstrated overutilization, contrast rxns, expense (500-2000)
CT is the gold standard for imaging what areas? chest, abdomen, pelvis, complex bony anatomy, acute head trauma
bone scan aka? scintigraphy
what does bone scan utilize? radioactive pharmaceutical (technetium 99MDP) that is injected intravenously
pros to bone scan very sensitive, can be sectional (SPECT), low whole person dose study (high GU dose)
cons of bone scan poor specificty, still has radiation, expense (300-1000)
Signs and sx of zenkers diverticulum food gets trapped in diverticulum - regurgitation of semi-digested food, hx of bad breath, difficulty swallowing.
complications of zenkers div aspiration pneumonia, bronchitis
what may be seen on plain film with zenkers diverticulum may see air-fluid level in front of c-spine in the retropharyngeal space
most ulcers are ___ and resolve in ___ weeks benign and resolve in 6 wks
2% of ulcers aren't ulcers, but represent what? necrosed tumor
where do the majority of stomach ulcers occur? along the lesser curvature, body, or antrum
What is the typical shape of ulcers? round or oval
how are ulcers seen on bairum? small outpouching of the barium column
Hamptons line rim of edema seen around the ulcer, indicative of a benign tumor
Three complications of ulcers obstruction, perforation, bleeding
perforation from ulcer? ulcer can extend thru the mucosa into free abdominal space, or into an adjacent organ
how does ulcer perforation appear on plain film? intraperitoneal air collects under the diaphragms on upright views. tis a serious complication
Hiatal hernia plain film ap and lateral views gastroesophageal junction goes up into the thoracic cavity. Airfluid level thru the heart shadow on the frontal view. On lateral see air/fluid level behind heart
Rule of 3s of normal small bowels no more than 3 air/fluid levels, no more than 3 cm of bowel distention, the distance between the folds should not exceed 3 mm
what is mechanical bowel obstruction casued by adhesions from previous surgery, hernias, neoplasms, intussusception, strictures from chrohns dz, volvulus
clinical findings of small bowel obstruction nausea, vomiting, cramping, distension
dynamic ileus sm bowel tries to force obstruction out by strong periastalsis, may be seen as dynamic motion on abdomen
adynamic ileus bowel becomes exhausted and stops all peristalsis. Air collects in dilated loops.
xray findings of small bowel obstruction dilated small bowel loops. Air fluid levels are seen on upright films proximal to the obstruction. The abdomen distal to the obstructions is usually gasless.
how do inguinal hernias appear on plain film? prescence of an enlarged scrotum that contains multiple loops of air-filled bowel.
where is classic crohns found predominantly? terminal ileum
early chrons reps? granulomatous inflammation
advanced nonstenotic phase of crohns? reps progression of inflammation wthout compromise of the bowel lumen
stenotic phase of crohns dz ? reps endstage dz, stenotic lumen from strictures
Radiology of early crohns dz? nodular enlargement of lymphoid follicles (cobblestone appearance - longitudinal and transverse ulcers separated by edema. Ulcerations, Skip lesions (discontinuous involvement with intervening normal areas - pseudodiverticula)
Radiology of stenotic phase of crohns string sign - marked narrowing of ridged loops from strictures, stenotic bowel may cause obstruction, usually surgically removed
Complications of crohns dz obstruction Fistula Formation: to hollow viscera (urethra, vagina). increased risk of carcinoma
what are colonic diverticulosis? small rounded outpouchings of colonic mucosa thru the colonic wall
50% pts with colonic diverticula over? 60
where are diverticula most numerous? sigmoid colon because of increased pressure owing to normal decrease in lumenal diameter
xray colonic diverticula when filled with air may be seen as asmall collection of air next to the normal gas pattern
contrast of colonic diverticula filled with contrast and deomnstate small lumenal outpouching adjacent to the normal contrast column
what is the hallmark ulcerative collitis? collar button appearance
what are pseudopolyps in ulcerative colitis? seen in acute and severe attacks. are islands of inflamed edematous mucosa seen between ulcerated areas.
What is lead pipe appearace of the bowel in ulcerative colitis? seen in chronic ulcerative colitis. it is fibrosis which leads to diffuse narrowing of the bowel lumen with a loss in any mucosal pattern.
what are complications of UC? toxic megacolon, stricture formation, malignancy
colonic involvement of us vs crohns crohns is right sided usually, uc is either left or universal
involvement of rectum in crohns and uc HALLMARK of uc
continuity of lesions in crohns vs uc crohns skips, and uc is continuous
fstula formation in crohns and uc more common in crohns
Created by: margaretrhager