2 Principles of Radiology X-rays (discovered late 19th century)Computed Tomography (CT scan)Sonography (ultrasound)FluoroscopyNuclear Medicine – used for diagnostic and therapeutic proceduresMagnetic Resonance Imaging (MRI)Positron Emission Tomography (PET)
3 X-rays Radiography High energy waves that cannot be seen or felt Similar to photographsRadiopaque – do not permit passage of x-rays i.e. bones; show up on x-rayRadiolucent – permit the passage of x-rays i.e. soft tissue; do not show up on x-ray
4 X-rays Patient Positioning 2-dimensional Requires 2 exposures 90 degrees to each otherMay require multiple positions and viewsReview standard positions in handouts and in textReview exam sequencing in textRadiation SafetyCan cause cellular or genetic damageMinimize exposureAvoid unnecessary examsLimit area of body exposedShield sensitive body partsPregnancy statusWorkers:Use shieldingWear dosimeter
5 Diagnostic Procedures Mammography –x-ray examination of the breastVital adjunct to biopsyPerformed yearly after age 40 or sooner with history or suspicion
6 Diagnostics cont… Contrast Studies Used to differentiate structures Introduced via IV, catheter, orallyIodine – blood vessels; if allergic to shellfish, do not use iodine!Barium – intestines and stomachAir - Joints
7 Fluoroscopy Use of x-rays to observe movement within body Contrast mediums used such as barium or iodineBlood flow, beating heart, digestive tractAlso used to aid in reducing fractures or implanting devices such as pacemakers, stents, etc..
8 Computed TomographyCross-sectional group of x-rays that target a specific siteTube circles the patient, computer analyzes to create the cross-sectional viewsDone with and without contrastOrgans can be viewed from all angles
10 Sonography Ultrasound Non-invasive Uses high-frequency sound waves Creates cross-sectional still views or views in real time movement with help of a computerUsed for heart function, abdominal and pelvic structure views and fetal visualization
12 MRI Magnetic Resonance Imaging Uses high-intensity magnetic fields (magnets), radio waves and computer analysis to create cross-sectional imagesUsed for central nervous system studies, joint structure, etc.Done with or without contrastClaustrophobia is an issueMetal implants from surgeries is a contraindicationPatient must remove any jewelry and other metal objects
14 Nuclear MedicineSmall amounts of radionuclides (radioactive materials) are injectedThese concentrate in specific areas of bodyComputer cameras detect particles and create an imageUsed to study thyroid, brain, lungs, liver, spleen, kidney, bone and breastPositron Emission Tomography (PET)Single Photon Emission Computed Tomography (SPECT)Assists with diagnosis of cellular abnormalities esp. cancer
16 Interventional Radiologic Procedures Designed to treat specific disease conditions – helps patients avoid surgeries, life-savingPercutaneous Transluminal Coronary Angioplasty (PTCA) – balloon angioplasty; used to enlarge lumen of blocked arteryLaser Angioplasties – use lasers to remove deposits in vesselsVascular Stents – plastic or wire tubes inserted into a constricted vessel to open it; this procedure is guided by fluoroscopyEmbolizations – artificially stop bleeding from a blood vessel or reduce blood flow to a diseased area of an organ
21 Radiation Therapy Major force in fight against cancer Uses high-energy radiation to kill cancer cellsUsed in conjunction with surgery and chemotherapy (drug therapy)Precise and carefully planned by radiation oncologist (MD specializing in radiology)Each treatment must be identical to a specifically defined area of the bodySide effects: weight loss, hair loss, loss of appetite, skin changes, digestive system disturbances
22 Patient Education & Preparation Help alleviate anxietyCalm fearsExplain proceduresExplain preparation – different for each test from no prep to liquid diet and laxativesAssist as neededPost procedure education
23 Handling and Storage of Radiographic Films Protect unexposed films from extremes of temperature and lightExposed films kept in protective sleevesMaintain patient confidentiality per HIPAACorrect labeling of patient filmsFilms obtained on site remain part of patient record – films belong to the site that performed the procedure; can be signed out by patient or sent by courier to specialist or PCPDigital films can be kept in the EMRWritten summary sent to providers of patient careTeleradiology – computed imaging and information systems; many places use (PACS) Picture Archiving and Communication System to store films on computersCan outsource films this way to other countries even for a radiologist to read films; consults with specialists from around the world is possible with this system and in rural areas
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