Radiology and Diagnostic Imaging

CHAPTER 20

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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

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• 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

Radiology and Diagnostic Imaging Overview

PROCEDURES AND TECHNIQUES

Radiology and Diagnostic Imaging

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• 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

Angiocardiography(Cardiac Catheterization)

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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

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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

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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

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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

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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

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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

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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

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Bronchography• Pronounced

– (brong-KOG-rah-fee)• Defined

– Bronchial examination via X-ray following the coating of the bronchi with a radiopaque substance

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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

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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

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• 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

Cholangiopancreatography(Endoscopic Retrograde)

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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

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• 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

Cineradiography

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• Pronounced– (kom-PEW-ted AK-see-al toh-MOG-rah-

fee)• Defined

– Painless, noninvasive diagnostic X-ray procedure using ionizing radiation that produces a cross-sectional image of the body

Computed Axial Tomography (CT, CAT)

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Computed Axial Tomography

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Voiding Cystourethrography• Pronounced

– (VOYD-ing sis-toh-yoo-ree-THROG-rah-fee)

• Defined– X-ray visualization of the bladder and

urethra during the voiding process, after the bladder has been filled with a contrast material

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Digital Subtraction Angiography (DSA)

• Pronounced– (DIJ-ih-tal sub-TRAK-shun an-jee-OG-rah-

fee)• Defined

– X-ray images of blood vessels only, appearing without any background, due to the use of a computerized digital video subtraction process

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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

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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

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• 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

Hysterosalpingography

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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

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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

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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

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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

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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

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• 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

Pyelography(Intravenous) (IVP)

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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

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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)

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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

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• 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

Scanning (Bone, Brain, Liver, Lungs)

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• Defined– Image of the area being studied is

displayed by recording concentration or collection of a radioactive substance specifically drawn to that area

Scanning (Bone, Brain, Liver, Lungs)

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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

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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

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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

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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

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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

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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

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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

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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

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• 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

Ultrasonography(Ultrasound)

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Ultrasonography• Abdominal ultrasound

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

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Ultrasonography• Pelvic ultrasound

– Noninvasive procedure that uses high-frequency 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

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• 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

Ultrasonography

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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

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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

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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

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• 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

X-rays