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Radiology 2
Ultrasound & Endoscopy
| Question | Answer |
|---|---|
| Assess the Patient What can we do to help if a patient is having difficulty breathing. | Pre-oxygenate (5 min with face mask, 20 minutes with oxygen cage). Minimize stress (quick, efficient, calm). May only be able to do dorsoventral view. |
| Assess the Patient If the patient is in pain, what can we do to help make them more comfortable and improve the end results? | If position is causing pain, STOP! Ask the DVM for instructions (different view, medication, sedation). |
| What do we call the quality factor that regulates the energy of the x-ray beam? | Kilovoltage (kVp). The higher the voltage, the faster electrons are accelerated, the greater energy of the x-ray beam. |
| True or false: higher kVp and lower mAs settings are for soft tissue. Lower kVp, higher mAs are used for bone structure. | True |
| ___ is the amount of electrical energy being applied to the filament...the quantity of x-rays produced during exposure. | Milliamerage (mA) |
| ___ is the period during which the x-rays are permitted to leave the x-ray tube. | Exposure time (in seconds) |
| True or false: use approved mechanical restraining devices to hold patients whenever possible. | True. |
| If holding a patient for a radiograph, what should you do? | Wear a lead apron, lead gloves, and a thyroid shield, keep out of the primary beam, and use chemical restrain on the animal when possible. |
| All living cells are susceptible to ionizing radiation damage, but what cells are most sensitive? | Rapidly dividing cells: growth cells, gonadal cells, metabolically active cells. Other that are sensitive: bone lymphatic, dermis, leukopoietic and hemopoietic (blood forming) and epithelial tissues. |
| What is an x-ray? | A form of electromagnetic radiation. Examples of other electromagnetic radiation: Gamma rays, radio waves, visible light, TV waves. |
| A ___ is an image produced on film due to x-rays. | radiograph |
| True or false: x-rays are not affected by magnetic fields. | true |
| True or false: x-rays travel at the speed of light. | true |
| True or false: x-rays and light act like waves traveling through space, act like particles when interacting with matter, travel in straight lines (they don't go around corners), and diverge from a point source. | true |
| To take advantage of the Heel Effect you should: | Place thicker body parts toward the cathode side (-) of the beam to produce a more uniform image. |
| True or false: unlike light, x-rays can not be focused by a lens. | True |
| True or false: x-rays only make shadow images. | True |
| A small x-ray beam results in a ___ shadow. | sharp. Therefore, for the sharpest image limit the aperture or "cone down" or "collimate down." |
| A large x-ray beam results in a ___ shadow. | fuzzy. Therefore, for the sharpest image limit the aperture or "cone down" or "collimate down." |
| What are three ways we can reduce scatter radiation? | No metal in region of x-ray beam. A grid made of lead is placed above some cassettes to absorb scatter produced by x-ray beams penetrating patient. Cassette is placed in the "bucky" under the table if mobile grid is built in. |
| Radiographic Views: Standard of Care A minimum of ___ view of any body region should be taken. | two |
| Radiographic Views: Standard of Care How many views of lungs are taken when evaluating for tumors? | three |
| Radiographic Views: Standard of Care True or false: it is recommended that identical views of opposite limb are done for comparison. | True |
| Radiographic Views: Standard of Care If you want maximum detail, you want to use the ___ image window possible. | smallest. "coning down" |
| Radiographic Views: What is a Met Check? | Metastasis Evaluation. Evaluation of lungs for metastatic tumors. 3 views minimum. |
| Setting X-ray Technique Measure thickness of area to be imaged at the ___ point. | Widest. Always use calipers. Measure in correct body position. Chest should be measured at the widest part: usually 7th rid in both views (behind shoulders). Abdomen measured at just behind last rib. |
| Technique Chart True or false: a chart should be developed specific to each machine (and developer). | True. Based on the measurement thickness and body region: thoracic, abdomen, bone. Focal-film distance must be constant (40 inches). |
| Technique Chart What six parameters are listed on the chart? | Thickness (cm). Study type (thorax, abdomen, bone). Exposure time (seconds). Quantity (mA). Energy setting-Quality (kVp). Film type and grid status (table top or bucky). |
| True or false: in veterinary medicine, we generally choose the technique with the shortest seconds to yield the goal mAs due to patient motion concerns. | True |
| ___ is the radiographic appearance of an object. It is related to how many x-rays can pass through the object. | Opacity. |
| True or false: objects that allow many x-rays to pass through are black (lungs). This is called radiolucent. | True |
| True or false: objects that do not allow many x-rays to pass through are white (bone). This is called radiopague. | True |
| Remember the physics of the image. ___ traveling through the patient and exciting fluorescence on radiograph screen. | Photons |
| Air is always ___. Bone is always ___. Tissues will be shades of grey based on density. Objects whiter than bone are ___ or ___. | black. white. rocks or metal |
| Exposure and contrast are determined by: | mAs and kVp. |
| True or false: exposure is how overall white or black the radiograph is and the number one factor of radiograph quality. | True |
| Technique Adjustment Summary Background | If too black, decrease mAs. If too light, increase mAs. |
| Technique Adjustment Summary Patient | If too black, decrease kVp. If too light, increase kVp. |
| Radiographic density is the contrast and detail of the image and is controlled by four exposures. Contrast is controlled by ___ and ___, while Detail is controlled by ___ and ___. | mAs and kVp. Focal-film distance (40 inches) and Object-film distance. |
| mAs Doubling the mAs will ___ the film exposure. | double |
| Different combinations of mA and seconds will equal the same mAs. Which do you choose? 300 mA x 1/30 sec = 10 mAs or 100mA x 1/10 = 10 mAs? | 300 mA x 1/30 sec = 10 mAs |
| Increasing the kVp by 20% will ___ film blackness (exposure). | double |
| Detail Small Focal Spot = | best detail |
| Detail: Object-Film Distance The ___ the object is to the film, the ___ the image. | closer. sharper. |
| Detail: Focal-Film Distance The ___ the film is to the x-ray tube, the more ___ and ___ of detail. | closer. magnification. loss. |
| A ___ is an optical density that is not anatomy. An unwanted density on the radiograph. Interferes with diagnosis. | artifact |
| What are some artifacts that result from action before processing? | fogged film, black crescents or lines, black areas, white areas, spots or streaks, white lines across film, clear film |
| What are some artifacts that result from action during processing? | Dark film/poor contrast. Light film/poor contrast. Clear film. White lines across film. Browning of film. |
| What are some important things to remember for best darkroom? | Organization is essential. Clean surfaces. Light leak free (will cause film fog): locate and seal all light leaks. Cool and low humidity. |
| True or false: the darkroom entrance is the source of most light leaks. | true |
| Film Identification True or false: Every radiograph should be properly labeled with essential information. | True |
| Film Identification True or false: a radiograph w/o proper labeling is of little value in a court of law. | true |
| Film Identification What five pieces of information must be on a radiograph label. if there is room, what else should be on the label? | Clinic Name/Veterinarian, Patient/Owner Name, Date (time if it is a contrast study). Species, breed, age, sex |
| Film Identification True or false: (leaded letters for film labeling) Left & Right markers are used to label extremities and side of recumbency. | True |
| Film Storage Unit Film must be stored properly. It must be protected from what four things? | light, heat, moisture, radiation |
| Unloading Film from Cassette True or false: fingernails should not be used. Handle film only by corners or edges avoiding fingerprints. | true |
| Positioning Aids Name several | sandbags, foam wedges, radiolucent troughs, straps, tape, gauze ties. |
| What are two major types of Digital Radiography Receptors? | Computed Radiography (CR) Direct Digital Radiography (DDR) |
| What are three advantages to CR? | Existing radiology rooms can use the technology. Due to similarities with traditional radiography, the learning curve is much shorter. The computer can adjust technique, decreasing the need for image "retakes" considerably. |
| What are some cons of CR? | Still need an imaging plate which is expensive. Same amount of time produce the image. Increased exposure when compared to film and DR (2x the mAs) |
| What are some advantages of DDR? One disadvantage? | No film cost. No darkroom space/processor maintenance. No films to search for or file. Increased productivity. Decreased retakes. Can see image immediately...like a digital camera. Con: super duper expensive. |
| Name the system that allows storing, retrieving, distributing of digital images throughout your hospital or the internet? | PACS (Picture Archiving & Communications System) |
| What is the name for the imaging "language that allows multiple pieces of medical equipment to communicate digital images? | DICOM (Digital Imaging and Communication in Medicine) |
| Exposure parameters that will yield a diagnostic image (shades of gray). | Latitude |
| Film radiography has a ___ latitude. | Narrow. Minor under or over exposure will fail to provide diagnostic image. Not possible to provide detailed image of bone or soft tissue in same view. |
| Digital radiography has a ___ latitude. | wide. kVp has virtually no effect on image quality. Detail of both bone and soft tissue in same exposure possible. |
| True or false: CR and DDR are more sensitive to scatter radiation than film. | True |
| What are four ways we can reduce scatter radiation from reaching the imaging plate. | Collimate (as kVp increases, scatter also increases). Reduce the kVp. Air gap technique. Add a grid. |
| What do you reduce kVp? | reduce by 15% an double the mAs to reduce scatter radiation. Multiply kVp by 0.85 to get a 15% reduction. |
| Every digital imaging system is equipped with an "Exposure Value Indicator" system. What does it measure? | overall exposure received by the plate for that particular exposure. |
| The Exposure Value Indicator system is inversely proportional. The optimal range is? | 150 - 300 with 150 being dark and 300 being light. |
| What is the Uberschwinger Artifact? | "over shoot" It causes the appearance of a fine black line halo. Result of implementation of edge enhancement. Can be mistaken for evidence of loosening of orthopedic device. Can mimic pneumothorax. |
| Skull: Patient Positioning (General Technique) True or false: nearly all patients require general anesthesia as positioning must be precise. | True |
| Skull: Patient Positioning (General Technique) True or false: the ET true usually need to be removed or re-positioned so as not to interfere. | True |
| Skull: Patient Positioning (General Technique) Measurement of the nasal passages is taken where? | slightly rostral to the widest area as to avoid over-exposing the air-filled sinuses. |
| View: Routine or Survey Skull Positioning (3)? Collimation? Remove what? Use what positioning aids? | Lateral (affected side down). DV or VD. Collimate tightly. Remove collars. Use foam wedges to achieve correct alignment for view. |
| General: Limb Radiography Long bones of the limbs should include the: | proximal and distal joints on the film |
| General: Limb Radiography Joints of the limbs: center the central x-ray beam: | to the joint under examination |
| General: Limb Radiography Comparative Films: take the ___ limb if there is a question as to what you are seeing and compare the ___. | opposite limb. two. |
| Why do we radiograph the skull? | Skull fractures, foreign bodies or tumors. Sinus cavity disease (infections or tumors). Tympanic Bullae disease (infections or tumors). Tempomandibular joint (TMJ) pain. Dental disease. |
| General: Limb Radiology True or false: long bones of limbs should include the proximal and distal joints on the film. | True |
| General: Limb Radiology True or false: center the central x-ray beam to the joint under examination. | True |
| General: Limb Radiology True or false: Comparative films: Take the opposite limb if there is a question as to what you are seeing and compare the two. | True |
| General: Limb Radiology: Views of the Limbs The most common are the ___ view and the craniocaudal or dorsopalmar/plantar. The different views silhouette different aspects of the bones. | lateral |
| General: Limb Radiology In a lateral view of limb bones and joints, the limb to be radiographed is placed on ___. Pull the affected limb ___ (lateral?) and retract the other limb. This view silhouettes the cranial and caudal surfaces of the bones. | on the cassette. forward. Craniocaudal or dorsopalmar views silhouette the medial and lateral structures of the limb. |
| The Pelvic symphysis is a cartilaginous joint ___ the two halves of the pelvis. | between |
| Radiology of the Spine: Anatomy is Complex True or false: many structures overlap complicating interpretation. | True |
| Radiology of the Spine: Anatomy is Complex Because of ___ ___ the interpretation is effected away from the center of the beam. | beam divergence |
| Radiology of the Spine: Anatomy is Complex Radiographic interpretation is compromised by poor ___. | positioning. |
| Radiology of the Spine: Anatomy is Complex Always take ___ views. Which two are most common? | two. Lateral and ventrodorsal. Add oblique views if necessary. |
| Radiology of the Spine: Anatomy is Complex True of false: the DVM may order dynamic views in the cervical and lumbo-sacral regions. Why is meant by dynamic views. | True. extended or flexed. |
| Radiology of the Spine: Anatomy is Complex True or false: Image each region separately, with the beam centered over the middle of that region. | True |
| Radiology of the Spine: Anatomy is Complex Image certain areas with ___ collimation (i.e. caudal cervical, thoracolumbar, lumbosacral). | more |
| Radiology of the Spine: Anatomy is Complex Proper patient positioning is ___. | critical |
| Radiology of the Spine: Anatomy is Complex True or false: Proper positioning requires anesthesia, ties for limbs, and sponge wedges. | True |
| Radiology of the Spine: Anatomy is Complex Intervertebral disc spaces must be ___ to the table top (not oblique). | perpendicular |
| Radiology of the Spine: Anatomy is Complex Vertebral column must be parallel to the table top. How can we accomplish this? | Support head, neck, and hip. Curved regions. |
| Radiology of the Spine: Anatomy is Complex The transverse processes of the vertebrae should be perpendicular to the table. How can we accomplish this? | Put spacers: foam, rolled towel, or blocks between limbs. |
| Radiology of the Spine: Counting Cervical Vertebrae Name three Landmarks: | Atlas (C1), Axis (C2), and C6 with large transverse processes. |
| Radiology of the Spine: Counting Thoracic Vertebrae Name two Landmarks: | T1 is actually just caudal to the first rib heads. T13 is the one with the last rib heads (complete). |
| Radiology of the Spine: Counting Lumbar Vertebrae What landmarks (2) can you use? | Use the sacrum to help you find L7 and then count backwards. Or find T13 and count forwards. |
| Radiology of the Spine: Cervical Spine Positioning Head ___. Front limbs pulled ___. Wedge under mid-___ region. Center beam over __-__. Measure at __. | extended. caudally. cervical. C4-C5. C7. |
| Radiology of the Spine: Cervical Spine - Ventrodorsal True or false: place rolled towel under cervical spine and tie thoracic limbs together and pull caudally. | True |
| Radiology of the Spine: Thoracic Spine Positioning: Front limbs pulled ___. Hind limbs pulled ___. Wedge under ___ (lateral). Center sternum over spine (VD). | cranially. caudally. sternum. |
| Radiology of the Spine: Thoracic Spine - Ventrodorsal Beam centered over caudal border of scapula T__. Measure at highest point of sternum. | T6 |
| Thoracic Spine - Lateral Center beam over T__. Measure at __th rib. | T7. 7th Rib. |
| Radiology of the Spine: Sacrum True or false: remember to aim x-ray tube 30 degrees cranially. Colon must be empty. Center beam over sacrum (L6 -illiac crest). Measure sacrum. | True. dorsal recumbency with legs in neutral position |
| Radiology of the Spine: Dynamic Views What is meant by a Dynamic View? | flexed or hyper-extended. Stress test. Be gentle and do not occlude airway. |
| OFA Hip Certification Name three animal requirements: | Dog or cat must be < 2 years old. Animal must be sedated or anethetized for proper radiographic technique. Females does should not be within 4 weeks of heat cycle (before and after) or of weaning pups. Hormonal influences will increase hip laxity. |
| OFA Hip Certification Name four radiograph info requirements: | Info must be in film emulsion-use of lead markers. Film labeled w/ ink or attached labels will not be accepted. Animal must be microchiped/tattooed-permanent ID. Required: Name and ID # of animal. Name of DVM or hospital. Date. DVM unique case number. |
| OFA Hip Certification Name three radiograph requirements: | Dorsal recumbency with rear legs extended and parallel to each other. Standard VD. Good contrast is desirable (high mAs, low kVp). Grid techniques are recommended for all large dogs. Sacrum and stifles must be included. |
| OFA Hip Certification There are seven classifications: | Excellent. Good. Fair. Borderline (for Hip Dysplasia). Mild (Hip Dysplasia). Moderate (Hip Dysplasia), Severe (Hip Dysplasia). |
| Technique Chart Purpose What is it? | It provides a consistent method of choosing proper exposure factors to create a diagnostic radiograph. |
| Unique Technique Chart True or false: every x-ray machine needs a unique chart specifically formulated because of variables (regardless of flat film vs digital). What are eight variables? | Input voltage and calibration. Speed and age of screens. Speed of film. Temperature and time of film processing. Type of grid. |
| Unique Technique Chart A Chart for Each: Name five factors | Screen vs non-screen, grid vs non-grid, species specific, anatomy specific, film-screen combos |
| Unique Technique Chart In general every practice should have ___ variable kVp charts! Name them. | five. 1. Extremity & Skull (no grid) 2. Abdomen (with grid) 3. Thorax (with grid) 4. Pelvis & Spine (with grid) 5. Avian & Exotics (no grid) |
| Technique Chart Formulation Name six supplies needed. | Flat-bottom bucket. Water. Ruler in centimeters. Radio-opaque phantom OR One 50# adult dog 5/10 BCS, short hair, 14" x 17" cassette. Medium speed x-ray film (400-speed) |
| Technique Chart Formulation Alternative to traditional technique? | water bucket technique. 1.0 + base + fog in our animals is equal to density of soft tissue cranial to iliac crest. |
| Technique Chart Formulation Describe the four steps. | 1. Test Exposure 2. Develop under ideal conditions 3. Evaluate radiograph: Too Dark - Decrease mAs or kVp. Too Light - Increase mAs or kVp. Repeat Test Exposure. |
| Technique Chart Formulation: Adjust Technique If changing kVp, change by __ - __ %. If changing mAs, change by ___%. | 10-15%, 50% |
| Technique Chart Formulation After ideal exposure found record in blank chart, then extrapolate technique chart. How is this done? | For every 1 cm of tissue, change kVp by 2. |
| Technique Chart Formulation: Other Tissue Types Thorax usually takes __-__% less mAs than abdomen. Pelvis or spine could take __-__% more mAs than abdomen. True or false: for extremities, the lowest mAs setting and table top technique is best. | 30-50% (Thorax compared to abdomen), 30-50% (Pelvis/Spine compared to abdomen). True. |
| kVp is static - Digital Radiography Under exposure to digital receptor leads to grainy texture called: | quantum noise |
| CR/DR Readers tell us Exposure Index The exposure index roughly tells us the quantity of radiation striking the ___ ___. | image receptor |
| CR/DR Readers tell us Exposure Index True or false: manufacturers give us a range to target for the best images and patient dose. | true |
| Technique Chart Development - Digital: kVp Describe the steps: | Start with a Universal Technique Chart. Use a phantom (or 50# dog) to determine ideal kVp (image receptor in bucky for abdomen) for specific machine/room. Then calculate fixed kVp chart. |
| Technique Chart Development - Digital: kVp When making a fixed kVp chart, once you have a good technique, measure the patient or the phantom. When the thickness measurement increases by __ cm ___ the mAs. | 6 cm. double mAs. |
| Quality Assurance: PPE Evaluation Logs of __ PPE equipment should be kept and __ equipment inspected on a regular basis (quarterly). Each piece of equipment should be ___ to be identified easily in the log. | all. numbered. |
| Quality Assurance: Radiographic Log Book The log (properly filled out) is a way to identify: | equipment failures or quality issues. For instance, if cassette #3 consistently produces fuzzy/light images with correct technique, the cassette should be serviced or replaced. |
| Source-Image Distance Mark SID Accuracy Equipment needed? Objective? | Tape measure, carpenter's level. To ensure the accuracy of the SID. |
| Collimation Accuracy Equipment Needed? Objective? | Steel tape measure. To ensure that the light field determined by the collimator dials is accurate. |
| Collimator Alignment Equipment Needed? | Cassette, 4 coins (1 larger) |
| What is a Step Wedge Test? | Evaluates your image receptor |
| Ultrasound is a ___ sound pressure above human hearing of 20 kHz. | cyclic |
| True or false: dogs, cats, bats, and mice can hear the ultrasounds produced by diagnostic ultrasound. | True |
| ___ is the medical imaging technique utilizing the interaction of high frequency sound waves with tissue. | Ultrasonography |
| True or false: ultrasonography uses the same principles used in SONAR. | True |
| ___ crystals inside the transducer change shape when an electrical current is applied to them. This change in shape generates the sound wave. | Piezoelectric |
| Ultrasound Image As sound travels through the body, some of the sound waves are absorbed. This limits how ___ sound waves can penetrate. | deep |
| Ultrasound Image True or false: difference tissues have difference absorption and reflection properties and generate different shades of gray and white. | True |
| Ultrasound Reflection The reflection or "echo" generated when the wave travels from one tissue type to the next is called an ____. | acoustic boundary |
| Ultrasound Reflection Due to the reflection properties, ultrasound can not image through bone or gas. Name four body parts or foreign bodies ultrasound can not image. | Air-filled lungs, gas-filled stomach or intestines, through ribs, through rocks, metal, or uroliths. |
| Ultrasound Machine The ___ applies high amplitude voltage to energize the crystals. | Pulser |
| Ultrasound Machine The ___ converts electrical energy to mechanical (ultrasound) energy and vice versa. | Transducer |
| Ultrasound Machine The ___ detects and amplifies weak signals. | Receiver |
| Ultrasound Machine The ___ displays ultrasound signals in a variety of modes. | Display |
| Ultrasound Transducers True or false: there are various shapes, sizes, and frequencies available for different purposes. | True |
| Ultrasound Transducers Veterinary medicine utilizes ___ array for imaging uterus through rectum of large species. | linear |
| Ultrasound Transducers Circular arrays are used for ___ and ___ studies. | cardiac. transabdominal. |
| General Technique True or false: furred areas are shaved? | True |
| General Technique: After Shaving Furred Area ___ or ___ position are used for small animal abdomen. | Lateral or ventrodorsal |
| General Technique: After Shaving Furred Area ____ lateral positioning is used for cardiac. | Right |
| General Technique: After Shaving Furred Area Large animal uterus and tendon studies are completed in a ___ position. | Standing |
| What is used in Ultrasonography to maximize skin/probe contact? | coupling gel or dilute alcohol |
| ___ rooms give best image for ultrasonography. | Dark |
| ___ rooms give best patient cooperation. What two other things can we do to increase patient cooperation? | Quiet. Calm demeanor of handler and comfortable body position. (foam cradles/tables, pillows, floor techniques.) |
| Four basic equipment needs of Ultrasonography? | Ultrasound machine. Positioning cradles, pillows, and table. Ultrasound gel. Clippers. |
| Ultrasound Modes __ mode: "brightness" mode is used for "real time" images. | B |
| Ultrasound Modes __ mode: "motion" mode is used to record changes in motion over time. It is used for measuring movement in the heart chambers. | M |
| Ultrasound vs Radiography Name six things Radiography is superior for: | Bone, lung, size of very large organs, gas-filled organs, counting late gestation fetuses, and time of procedure. |
| Ultrasound vs Radiography Name six things Ultrasound is superior for: | Subtle tissue changes, motion diagnostics, collection techniques, safety, and fluid-filled abdomen or chest. |
| Ultrasound Technique Image area is read in a specific pattern (clockwise). All organs must be imaged twice. How is this accomplished? | Longitudinal and transverse |
| Ultrasound Technique What are three ways that ultrasound can assist in sample collection? | Urinary cystocentesis (sterile). Cytology (tumors, fluid, organ (spleen, lymph node). Biopsies (liver, kidneys, tumors). |
| Ultrasound-guide Biopsies Requirements True or false: aseptic technique, general anesthesia, clotting test, biopsy needle, formalin. | True |
| Ultrasound Pregnancy Ultrasound can first detect pregnancy in the dog at ___ days of gestation. | 17 days |
| Ultrasound Pregnancy Heartbeats can be seen at ___ days gestation. | 25 days |
| Ultrasound Pregnancy True or false: counting puppies can be difficult due to folding of uterine horns (especially later in pregnancy). | True |
| Ultrasound Eye Can place ultrasound probe directly on eye or eyelid (sterile lube used). What three inner structures can be visualized? | Lens, Retina, Tumors. Retrobulbar Abscesses can be visualized behind the eye. |
| Color-Flow Doppler The ultrasound machine can assign color to different directions of fluid movement. This is used to evaluate blood flow through the ___ and ____. | heart. blood vessels. |
| Describe four things every tech needs to know to properly care for the ultrasound machine. | Never drop or hit transducer. Keep transducer in its rack when not in use. Use diluted alcohol to clean transducer. Keep dust-cover on machine when not in use. |
| What are six key responsibilities for the role of vet techs in ultrasonography? | Equipment readiness. Entering patient info into log book. Entering patient info into ultrasound machine. Patient readiness. Animal handling/restraint. Procedure/anesthesia assist. |
| "Skopeein" means to: | to see |
| Greek word for "Endo" means: | inside |
| Endoscopy instrumentation consists of: | very small cameras attached to either a flexible or rigid tube. |
| True or False: Direct viewing of the interior of an organ is often very helpful in determining the cause of a problem and helpful in establishing a diagnosis, especially small animal GI disorders. | True |
| Types of Endoscopy Visualization of esophagus, stomach, and duodenum: | Endoscopy |
| Types of Endoscopy Visualization of the colon: | Colonoscopy |
| Types of Endoscopy Visualization of urinary bladder: | Cystoscopy |
| Types of Endoscopy Visualization of trachea and bronchi: | Bronchoscopy |
| Types of Endoscopy Visualization of nasal passages & pharynx: | Rhinoscopy |
| Name some instruments needed to perform an endoscopy. | Biopsy forceps, graspers, snares |
| What are four advantages to endoscopy? | Diagnostic as well as therapeutic applications. Minimum stress & mortality. Less traumatic than standard surgery. Amount & duration of anesthesia much less than standard surgical procedures. |
| What are three disadvantages of Endoscopy? | Requires expensive, flexible equipment and specialized operator training. Biopsies usually adequate, but not as good as full thickness surgical biopsies. Cannot examine entire intestinal tract; lesion may be beyond reach of scope. |
| True or false: inexpert handling of the endoscope may lead to poor diagnostics and complications such as punctured organ or vagal effects of over inflation. | True |
| GI Endoscopy Name seven pieces of instrumentation: | Endoscope, light source, water reservior, lube (water soluble), biopsy and snare instruments, tissue cassettes & formalin, CLO medium for Helicobacter. |
| GI Endoscopy: Procedure Support What equipment is necessary? | General anesthesia, cuffed endotracheal tube, oral speculum, EKG monitor, other monitoring equipment |
| Endoscopic Biopsy Multiple samples are taken from each region of the stomach and duodenum. How many is ideal? | 5 |
| Endoscopic Biopsy After sample has been collected it is gentle placed: | on balsa wood or a cassette with 22 g needle |
| Endoscopic Biopsy The sample is rapidly placed in formalin or test medium to prevent: | drying |
| GI Biopsies What are two tests used to evaluate a sample for Helicobacter? | Direct visualization on histopathology. Urease production test (CLOtest) - Positive within 4 hours. |
| Foreign Body Removal It is limited to ___ objects that can be brought back through the gastroesophageal junction that instruments can grasp. | gastric |
| Foreign Body Removal Extreme care must be taken to protect the esophagus. What are two techniques that can accomplish this? | Sleeve technique. Push esophageal foreign body into stomach for gastrotomy. |
| Colonoscopy What are four indications: | Chronic diarrhea. Recurring constipation. Chronic tenesmus. Chronic blood, mucous in feces. |
| Colonoscopy How do we prep a patient for this procedure? | Proper patient prep is essential for colon visualization. Patient must be fasted for a least 24 hours. Go-lytely or other osmotic for 2 days. Warm water enema (no irritant additives) if fecal material in colon can be seen on radiographs just prior to sx. |
| Colonoscopy: Instrumentation Name four pieces of information: | Similar to Upper GI endoscopy. Colonoscope is shorter, larger diameter than upper GI endoscopy. Patient is usually placed in sternal recumbency. General anesthesia. |
| Rhinoscopy What are four indications for this procedure? | Chronic nasal discharge. Epistaxis. Violent sneezing. Nasal Stridor. |
| Rhinoscopy Name two patient prep procedures: | general anesthesia (deep) + topical lidocaine. Sternal recumbency. |
| Rhinoscopy Instrumentation? | Rigid scope (arthroscope). Flexible endoscope (retroflex view). Light source. Biopsy or grasping instruments. Dilute epinephrine for topical use (bleeding can be problematic). Formalin, possible culture medium. |
| Bronchoscopy For large dogs, brochoscopy is performed through the: | endotracheal tube. |
| Bronchoscopy For cats and small dogs, procedure performed with: | intermittent intubation |
| Bronchoscopy Anesthesia is maintained with: | injectable agents (i.e. Propofol) |
| Bronchoscopy True or false: a sterile scope is utilized. How is it cleaned? | True. Cold sterilization (i.e. glutaraldehyde). Then thoroughly rinsed with sterile saline. |
| Bronchoscopy Cultures and cytology can be collected with: | cytology brushes |
| Bronchoscopy Foreign bodies can be removed with: | graspers |
| Endoscopy Equipment Care What are two goals of endoscope care: | Patient safety. Maintaining proper endoscope function. |
| Endoscopy Equipment Care Endoscope care means proper cleaning and disinfection, plus routine inspection of the instrument. Careful inspection of the scope should take place at what three stages of the endoscope use cycle? | Before use. During Use. After use. |
| Endoscope Handling Extreme care must be taken not to bend the flexible scope aggressively. Tight bends in the scope result in ___ breakage. | fiber |
| Endoscope Handling True or false: if an animal were to bite the scope, severe damage would occur to the fibers; use mouth gag. | True |
| Endoscope Handling One broken fibers obscure the image, the instrument must be ___. | discarded. Do not drop the scope. |
| Leak Testing It is extremely important that the flexible endoscope be leak tested before cleaning (submerged) every time. Why? | Submersion of an endoscope that has a leak will allow water to enter into the instrument and potentially ruin it. |
| True or false:The teeth of the animal are at high risk of damaging (causing a leak) in the flexible scope and care must be taken when moving the scope over the teeth. | True |
| Endoscope Inspection During Use If one of the following occurs during endoscope use, this would support fluid has leaked into the instrument and it should be taken immediately out of use until serviced (3): | Image stains. Foggy images. Electrical malfunctions. |
| Leak testing To conduct a leak test, apply ___ pressure to the inside of the endoscope insertion tube and watch for either a ___ in the pressure gauge or for ___ where there are leaks in the exterior or a channel wall. | air. drop. |
| Endoscope Cleaning True or false: Immediately after procedure is complete, copious amounts of fresh water should be suctioned through channels. | True |
| Endoscope Cleaning Manual cleaning with an ___ detergent, including the brushing and flushing of all accessible endoscope channels, then thorough rinsing with fresh water. | enzymatic |
| Endoscope Cleaning All removable parts should be removed to be cleaned. Air is then blown through the instrument and it should be carefully ___ to air dry. | hung |
| Endoscope Cleaning Alcohol on cotton swabs can be used for ___ parts. | handpiece |
| Endoscope Cleaning Instrument must be ___ prior to submersion. | sealed |
| Endoscope Cleaning True or false: follow all manufacturing recommendations for specific chemical agents. | True |
| Endoscope Cleaning Cold sterilization and sterile rinse much be performed immediately prior to any ___ procedure. | sterile |
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