radio 250 e1 lec 01 intro to radiology and radioprotection

7/21/2019 Radio 250 E1 Lec 01 Intro to Radiology and Radioprotection

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RadioLEC 1: Intro to Radio + Radioprotection

agAhmad and Lorvin

• %ir+t iaging odality u+ed or in+ertilit! +tudie+to rule out organic cau+e+

E"ite triangle terine cavit!

• Noral "y+tero+alingogra: t"ere i+ +ill o contra+t aterial in t"e eritoneu ."ic"indicate+ atency o t"e %alloian tu&e+

B. ANGIOGRAPHY

• +ed to )i+ualie )a+culature contra+t .it"in)a+cular +tructure+3

• Di+tally +u&tracted/re)er+ed contra+t i+ &lac>

• 8old +tandard or diagno+i+ o +tro>eo 6( &ecau+e it i+ tie-con+uing and +tro>e

i+ an eergency$ C( +can i+ reerred

• ery e. doctor+ do inter)entional radiologyo Radiation e,o+ure )ery "ig" ay lead to

cancer$ dryne++ o +>in and.rin>le+

• %eoral arter! i+ u+ually u+edo @a+ier to *nd and t"read t"e needleo 6a+ic +>ill needed in eroring t"i+ i+ A68

(Bo t!'es o+ contrast sed:o ,onic contrast ore allergenico onionic contrast "yoallergenic

("e +tandard contra+t in C( +can+ today H-J tie+ ore e,en+i)e t"an ionic

contra+t

• (Bo t!'es o+ contrast sed:

• 0tandard angiogra'h!: )e++el+ aear ."ite.it" +tructure+ in t"e &ac>ground

• Digitall! s)tracted angiogra'h!: all non-contra+t iage+ are reo)ed< )e++el+ aear&lac>

• -el+oam or alcohol em)oliCation: or &rainaneury++< t"eraeutic

• 3igtail catheter:

o In renal angiogra"y< indicated or "ig"-)olue contra+t rocedure+

o Mo+t oten u+ed in >idney tran+lant +urgeryre-oerati)e a++e++ent or donor+3

o +e+ large )olue o contra+t to +ee i t"euta>e o &ot" >idney+ are t"e +ae

,$A-2 R2%ALL

• Angiogra+ +"o.ing cere&ral di+tri&ution o &lood )e++el+ int"e early arterial and caillary "a+e+7 An outouc"ing can&e o&+er)ed in t"e region o t"e arietal lo&e< t"i+ i+ ananer!sm7

• Bidney angiogra u+ed to a++e++ ."ic" >idney i+ ea+ier to"ar)e+t7 A ig-tail cat"eter can &e +een7 ("e rig"t >idney "a+only one artery connecting to t"e aorta$ a+ oo+ed to t"eone at t"e let ."ic" "a+ 2-H )e++el+ connected to t"e aorta7

("ereore$ t"e let >idney i+ "arder to e,tract &ecau+e t"ereare ore )e++el+ t"at .ill need to &e ligated7

C. ULTRASOUND

istor!

• 6egan a+ =ONAR u+ed &y t"e ilitary

• Medically &ecae oular in t"e 1'K0+

• Inno)ation+ no.aday+ include 2D$ HD$ JD$Doler and color

o JD: u+ually or etu+$ c/o O6$ t"e ourt"dien+ion i+ time +o t"i+ i+ a )ideo

-eneral <eatres

• ;ig"-reFuency +oundo %reFuency o +ound a&o)e t"e range o

"earing 20 ; to 20 B;3o Medical ultra+ound u+e+ )alue+ .it"in t"e

range o 1 to 20 M;

•No electroagnetic radiation: in+tead u+e+ +ound.a)e+

• ("e ro&e coe+ in dierent +"ae+ and +ie++ince (P "a+ dierent u+e+< not Qu+t or+tudying t"e un&orn c"ild$ &ut al+o ora&doen$ el)i+$ t"yroid$ &rea+t and te+te+

•Can c"aracterie le+ion+ +olid$ cy+tic$ calci*c3

•May &e u+ed a+ guide or inter)entionalrocedure+ t"oracocente+i+$ &io+y3

•Real-tie: &ot" an ad)antage and di+ad)antage<you cannot &lae +oeone ."o did it &eore i current *nding+ are dierent

•Oerator-deendent

•Can a++e++ )a+culatureo (urn ON t"e Doler to dierentiate area+ o

tur&ulent Go. or dilated )e++el+ and duct+

•ie.ing (P re+ult+: loo at the W/L2'ictre and analye t"e +urrounding+tructure+

Reading *ltrasond <indings

• %luid [or den+ely Guid]: "yoec"oic &lac>3

• arying den+itie+: "yerec"oic< u+ i+ 8RA

• 8all&ladder +tone+: "yerec"oic .it" o+terior+onic shadoBing +ound "it+ t"e +tone andec"oe+ &ac> t"u+ no iage i+ ored &eyondt"e +tone3

,$A-2 R2%ALL

• (P o gall&ladder +"o.ing +tone+7 8all+tone+ u+t "a)e +o+"ado.ing to &e identi*ed a+ +uc"7

• (P o li)er< ta>e note o it+ c"aracteri+tic +tructure7 ;eaartery and coon &ile duct .ere +"o.n7 (urn ON tDoler to +"o. Go. and dierentiate arterial ro )eno)e++el+7 Coon &ile duct "a+ +luggi+" Go. o Guid ."cant &e ic>ed u &y t"e Doler7

• (P o >idney$ +"o.ing a dilated collecting +y+te7 ("i+ i+ nnece++arily a ro&le +ince t"e atient+ are u+ually a+>ed"old t"eir )oiding &eore t"e ultra+ound i+ done7 o+t-)ot"i+ +"ould noralie7 Laterality o >idneyS Di+tingui+" loo>ing at adQacent +tructure7 In t"i+ ca+e$ li)er i+ near&y rig"t >idney7 =@ (;@ @N(IR@ IMA8@$ not Qu+t t"e >idney7

*ltrasond in 3regnanc!

• 8enerally u+ed to +tudy t"e etu+

• ;o.e)er$ ay not &e entirely +aeo A 6riti+" +tudy ound t"at c"ildren undergoing

+e)eral ultra+ound+ a+ etu+e+ ended u .it""earing ro&le+




agAhmad and Lorvin

o ("i+ i+ o++i&le due to "ig" reFuencyaecting t"e oration o t"e inner ear

o =tudy dicult to relicateo A+ a recaution$ do not do too uc"

ultra+ound during t"e *r+t trie+ter ."enorganogene+i+ i+ +till in ull +.ing3 .ait untilt"e +econd trie+ter

D. COMPUTED TOMOGRAPHY (CT) SCAN

• HT0 9-ray+ in an arc"o A lot o 9-ray+: HT0 circuerential ,-ray+

reorganied and interreted &y couter$ t"u+called glori*ed 9-ray

o ("at+ HT0 9-ray+ @R =LIC@U =o i 50 +lice+: HT0 ,-ray+ (IM@= 50

• More radiation &ut ercei)e+ ore inorationo Ma>e +ure t"at t"e atient need+ it7 @n+ure

Qudiciou+ u+eUo 8et a C( +can i doing @ and (P .ill "urt t"e

atient and i you +u+ect an a&doinal aortic

aneury+ ul+atile a&doen3• @)olution: con)entional +iral ulti-+liceo ("e 4+lice )alue i+ t"e nu&er o cro++-+ection+

t"e C( can roduce in one +econd7 8; "a+ 2-+lice."ile =t7 Lu>e+ "a+ TJ-+lice7

*ses o+ %( 0can

• %or urt"er e)aluation o an ,-ray le+ion

• +ed or +creening or +inu+ di+ea+e &ecau+et"ere i+ no .ay t"at you can +ee t"e +inu+ro t"e out+ide3 and certain lung di+ea+e+

• 6e+t or +tudying &one+< al+o u+ed oraneury++$ &rain a++e+ and eta+ta+i+$+tro>e+$ "eorr"age+$ +taging o neola++$a+iration o cy+t+$ or &io+y o a++e+ C(-

guided &io+y3• A++e++ent o alignancy or eta+ta+i+ +ee

e,lanation in Iage Recall +ection &elo.3

,$A-2 R2%ALL

• A&doinal C( iage +"o.ing t"e tran+)er+e colon$ +leenand li)er7

• 6rain C( iage +"o.ing ultile le+ion+7 E"en re+ented.it" +uc": metastasis vs. 'arasitic in+ectiono Meta+ta+e+ are u+ually accoanied &y )rain edema< t"e

roce++ i+ a+ter$ and edea i+ a Fuic> reaction to a+udden in+ult

o ara+itic inection DO@= NO( re+ult in edea &ecau+e t"i+i+ a +lo. roce++ and t"e &rain i+ a&le to adat

• C( iage o a laterally-laced .ell-de*ned enca+ulatedcy+tic a++ in t"e nec> area7 ("i+ i+ o+t li>ely &enign$ a&ranc"ial clet cy+t7 Reo)e entire ca+ule7o Midline cy+t+ on t"e nec> t"yroglo++alduct cy+to Lateral cy+t+ &ranc"ial clet cy+t congenital3

• HD C( iage +"o.ing a )ery large a&doinal aorticaneury+$ an-renal in nature$ already aecting t"e cooniliac+7 E"at can you doS Not"ing7 ("ere i+ no ot"er )e++elt"at can +er)e to &y-a++ t"e aneury+7 Al+o$ lacing a +tent.ill not .or>< t"e e+" around it .ill Qu+t old on it+el +o t"atit *t+ on t"e +tent$ t"u+ o&+tructing Go.7

• 6one .indo. o C( to +"o. ro+t"e+i+7 ro&le: ortion+ are

+tic>ing out o t"e &one$ need ro+t"e+i+ adQu+tent7 atiei+ o&liFuely o+itioned and cant lie +traig"t7

igher Resoltion %( 0can $achines

• C( angiogra"y$ C( )enogra"y$ C( colono+coy$HD recon+truction

32(%( scano %u+ion .it" @( i+ t"e &e+t >ind out t"ereo @( +"o.+ +nction ."ile C( +"o.+

strctreanatom!Reading %( 0can <indings

•Elac : air/at h!'odense3

•White: Guid/+olid organ+ h!'erdense3

E. MAGNETIC RESONANCE IMAGING (MRI)

•DO@= NO( in)ol)e radiation$ 6( u+e o a +trongagnet cau+e+ moleclar realignment

o Ma>e+ u+e o t"e realignent o t"e +in o "ydrogen nuclei under a +trong agnetic*eld and u+e+radioreFuency radiation to

generate an iage o +ot ti++ue+$ ."ic"contain t"e o+t .ater and"ydrogen ato+3

•6e+t or +ot ti++ue )i+ualiation$e+ecially +ine$&rain and u+culature

•6one detail i+ not great in MRI +o or &one$ C(+can i+ +till t"e reerred odality

•$etastasis: +till t"e o+t coon &rain tuor

,$A-2 R2%ALL

• 6rain MRI +"o.ing +etation+$ ca+ulation+$ and necrotic o ("i+ i+ glio)lastoma mlti+orme$ t"e .or+t CN= tuery &ad rogno+i+: .it"out treatent$ atient i+ dead .itT ont"+< .it" treatent$ it &ecoe+ ' ont"+7

• 6rain MRI +"o.ing a ituitary tuor .it" intratmo)leeding$ ."ere t"e area+ in+ide t"e tuor +"o. a ."

regi+ter7• Bnee MRI +"o.ing an ACL tear$ coon in +ort+ inQurie+7

• =inal cord MRI: you can +ee e)eryt"ingU

F. NUCLER MEDICINE

• +e o radioacti)e i+otoe+ to ea+ure unction

• Not clear icture+< ;OE@@R t"e+e are"y+iologic iage+

(!'es o+ 0cans *sed in clear $edicine

Eone scano Mo+t coonly u+edo 6lac> ortion+ rere+ent "ig"ly eta&olied

area+

o ic>+ u AN(;IN8: it i+ )ery +en+iti)e &ut not+eci*c7

o =ecially u+ed to *nd eta+ta+i+

• (h!roid scan: unctional +can t"ere +"ould &e"oogenou+ di+tri&ution3

32( scano +e+ gluco+e ."ic" i+ a&+or&ed &y acti)ely

eta&oliing area+$ t"u+ not u+ed or &rain&ecau+e t"e &rain i+ ALEA= eta&oliing




agAhmad and Lorvin

o +ed to onitor treatent$ NO( &eorediagno+ing

o ("e only indication or u+ing @(-C( =can&eore treatent i+ i you dont >no. ."at totreat

o @( co+t+ V0$000$ @(-C( co+t+ 120$000 t"at i+ ."y &io+y i+ c"eaer

$!ocardial scan

• F scan: gold +tandard or ulonaryt"ro&oe&oli+ &eore$ &ut no. C( +can i+u+ed

(hallim scan

Renal +nction scan 6D$0A7 D(3A

Liver scan

,$A-2 R2%ALL

• Noral t"yroid +can7 Not really t"at clear in ter+ o )i+ualiation7 ;o.e)er$ t"e concern "ere i+ t"at o iodineuta>e: it u+t &e di+tri&uted "oogenou+ly7

• 6one +can: loo> or 4"ot area+ "yereta&olic area+ +uc"a+ lu&ar and cer)ical +ine3

• @(-C(7 ("i+ i+ u+ed to +ee t"e unctioning a++ relati)e to."ere it i+ anatoically located7 Do not do or an untreatedle+ion7 8et a C($ t"en &io+y$ t"en treat7 +e @(-C( to c"ec>or any re+idual cancer cell+7

III. RADI'T)!RA*+

• +ed in radiation oncologyo 2Gternal )eam radiation thera'! 62ER(:

con)entional$ HD conoral$ inten+ity-radiatedo 0tereotactic radiosrger! - +ource i+

out+ide t"e &ody &ut it+ concentrated intola+er-li>e &ea+

o Erach!thera'! - +ource i+ lace in+ide t"e&ody

u+ually done or ca+e+ o cer)ical$ t"yroidand ro+tate cancer+

HD conoral i+ &etter t"an &rac"yt"erayor na+o"aryngeal CA

• %or treatent o alignancie+ and &enigncondition+ .art+$ "yertro"ic +car+3 &utu+ually t"e la+t re+ort

• +e+ "ig"-energy gaa ray+

• @6R( or &rac"yt"erayo Co&alt

+e+ gaa ray+

Le++ rotecti)e &ecau+e e)en i you turnedo t"e ac"ine$ t"e rod .ill +till eitradiation

;ead "a+ to &e lined .it" T-V inc" lead +la&a+ counter .eig"t

o Linear accelerator +e+ electricity$ +o it i+ +aer t"an co&alt

No need or counter .eig"t

/L RAD,/L/-,% 2$2R-2%,20 ? - entioned

&y Maa3

• =C +yndroe?

• 6rain "erniation

• =inal cord core++ion?

• ery &ad non-+toa&le3 )aginal and intrana+al&leeding?

3AR( (W/: RAD,/3R/(2%(,//*(L,2 *n

included in the exam

I7 8eneral InorationII7 Ri+>+ o Radiation @,o+ureIII7 Radiation alue+I7 Radiation in Medicine7 %inal Eord+

I. &!#!RA( I#"'RMATI'#

A. USES OF RADIATION

(a)le 1. *ses o+ Radiation

•

MILI(AR /

ARAMILI(A

R =@

• Radiation a+ .eaon i7e7 atoic&o&3

• Eeaon+ o a++ de+truction EMD3

• 4Dirty &o&+ &o&+ .it" radioactiaterial3

- en)ironent &ecoe+ radioacti)e

- al+o aect t"e *r+t re+onder+

doctor+$ olice$ olitician+$ etc73IND=(RIAL

=@•Ci)il engineering c"ec> integrity o

inra+tructure+3

•=teriliation canned good+ to rolong+"el lie: radiation +lo.+ do.n t"eaging roce++ o ruit+3

M@DICAL

=@

Diagno+tic and t"eraeutic

B. IS RADIATION SAFE

• It can &e +ae

• ("ere i+ no +uc" t"ing a+ 4+ae do+e o radiation

• ("ere i+ no t"re+"old do+e ."erein )alue+&elo. ."ic" radiation i+ +aid to &e 4+ae

• 6( it ay &e )ery &ene*cial to atient+

C. RADIATION-CANCER LINK

• Only ro)en cancer+ are:o Melanoa due to and not ioniing

radiation3o ("yroid cancer gaa ray+3o Leu>eia

D. RADIATION POISONING

• Radiation .ill aect acti)ely di)iding cell+

• Recall B86 e&er ."o deected to 8reat6ritain and &ecae )icti o oloniuoi+oning in 2002o oloniu in tea ended u in "i+ 8I(

• 6ecau+e o i+ an Hemitter ."ic" are .ea>ert"an W-eitter+ t"at can ea+ily ierce t"e &ody3$t"e radiation "it t"e .all o t"e e+o"agu+$&ounce+ o t"e 8I tract$ and >ee going until




agAhmad and Lorvin

radiation le)el+ are +o "ig" t"at deat" &ecoe+ine)ita&leo o+torte in)e+tigation: CaX .a+ +till

radioacti)e$ a+ .ell a+ t"e &u+/ta,i/a&ulancet"at "e rode

II. RI% '" RADIATI'# !X*'UR!

A. IS IT SAFE TO STAY IN THE DEPT OF RADIOLOGY?

• @=$ it i+ +ae in t"e lecture roo and t"ereading roo

• 6( NO( in+ide t"e 9-ray roo$ and NO( in+idet"e co&alt rooo ou run t"e ri+> o &eing e,o+ed to +catter

radiation +o a)oid lingering on t"e+e area+B RADIOLOGIST MANTRA

• (,$2: t"e +"orter t"e tie o e,o+ure$ t"e&etter

• D,0(A%2: t"e art"er you are ro t"e +ource$t"e &etter

• 0,2LD,-: &a+ically to rotect your+el ro+catter radiation

??("e rea+on or t"e lac> o +ignal in t"e Radio

deartent i+ t"at .all+ .ere created .it" certain

t"ic>ne++ to .or> a+ a +"ield ro t"e radiation7 ("e

door+ are lead-lined to +er)e a+ rotection ro t"e

radiation a+ .ell7

C. WHAT HAPPENS WHEN HUMANS ARE EXPOSED TO

RADIATION?

Radiation 0icness

• asea and vomiting: u+ually t"e *r+t +ign$e+7 .it" lo. do+e+

Weaness

Elood changes

o Iediate ."ole &lood relaceent u+t &edone ancytoenia3 In 8;$ ."ole &lood i+ +carce &ecau+e o+t

o t"e tie$ it i+ di)ided into dierent &loodroduct+

o ro&le: arro. ay "a)e died out$ ayneed &one arro. tran+lant

• air loss: "ig"ly +ugge+ti)e o radiation+ic>ne++ ."en all o t"e a&o)e entioned+yto+ are al+o re+ent< )ery clo+e to deat"at t"i+ oint

• Death: u+ually .it" )ery "ig" do+e

• Ater +yto+ occur$ good +uorti)e care i+nece++ary

Radiation 2Iects

• Eor>+ &e+t in acti)ely-di)iding cell+

• 8u "eorr"age$ etec"iae$ aloecia$ +>in&li+ter+

D. WHAT HAPPENS WHEN FETUSES ARE EXPOSED TO

HIGH DOSES OF RADIATION?

(a)le ". %onse;ences o+ igh Dose

Radiation 2G'osre to <etses

•

R@-

IMLAN(A(ION

=(A8@

• Lo. c"ance+ o congenital anoalie+&ecau+e t"e &a&y die+

• ;ig" do+e+ are let"al to t"e &la+toer

Qu+t &eore ilantationOR8ANO8@N@

=I=• ;ig"er reFuency o congenital

anoalie+

• Mo+t dangerou+ &ecau+e a lot o.oen dont >no. t"eyre regnant

%@(AL =(A8@ • %etu+e+ can tolerate radiation$ le++erin+tance+ o let"ality and congenitalanoalie+ reorted

• Anoalie+ ay not &e re+ent during&irt" &ut aear only ater +e)eralyear+ e7g7 aillary t"yroid cancer&enign3 ater 20 year+3

E. WHAT HAPPENS WHEN YOU ARE EXPOSED TO SMALL

AMOUNTS OF RADIATION?

0lee'iness: rotecti)e unction o t"e &ody

• nger: 8I c"ange+$ uco+a +loug"+ o al+oe,lain+ nau+ea/)oiting3

• %hange in menstral c!cle: a little radiationcan +tiulate t"e ollicle to erut and "elinduce regnancy

F. HOW MUCH RADIATION IS TOO MUCH

,A2A %R3 Recommendation o+

AlloBa)le Radiation 2G'osre

• Lay er+on: 5 =) illi=ie)ert+3 /yr

• Occuational .or>er: annual a)erage o 20 =)

o)er 5 year+$ +"ould not e,ceed 50 =)• 3atient: no limit set< .eig" t"e ri+>+ )+7

&ene*t+

III. RADIATI'# ,A(U!

A. NATURAL RADIATION

".9@ m0v!ear average

• @,ternal +ource li>e co+ic 072T =)3 andgaa ray+ 072V +3o =ace radiation

Oone layer &ut no. it "a+ "ole+3

o Deo+it+ o radioacti)e atter @a+tern @uroe$ =out" Aerica$ Nort" Borea

o Land =oil "a+ radiation &ut in inute aount+

Mountainou+ area+ contain "ig"er aount+o naturally occurring radioacti)e aterial+a+ coared to Gatland+

=oe land area+ do contain naturally "ig"erradioacti)e aterial+$ &e+t to a)oid t"e+earea+

• Internal +ource t"roug" inge+tion car&on andota++iu containing ood3 and in"alation




agAhmad and Lorvin

B MEDICAL RADIATION

.5@ m0v!ear average

I,. RADIATI'# I# M!DICI#!

• Ee cannot control e,o+ure to natural radiation

&ut .e can control e,o+ure to edicalradiation7

A. HOW MUCH RADIATION DO I GET?

1 c"e+t 9-ray .# m0v Lot+ o air1 a&doinal 9-ray .55 m0v Lot+ o organ+1 el)ic 9-ray .#5 m0v Organ+ Y &one1 e,treity 9-ray .1 m0v =all &one$2A,-:eri++i&le do+e+ lay

er+on+3

to 5 =)/yr

Natural radiation H =)/yrMedical radiation No ore t"an 2 =) er

year

WA( ,0 2F*,AL2( (/ " m0v= eit"er o t"e

ollo.ing3:

• HH c"e+t 9-ray+ dont need uc" radiation&ecau+e a lot o air3

• HZ a&doinal 9-ray+

• H el)ic 9-ray+

• 200 e,treity 9-ray+ &y )irtue o +allne++3

C WILL I GET STERILE IF I HANG AROUND RADIO DEPT?

• It deend+ on "o. "ig" a do+e one .a+ e,o+edto &ut o+t li>ely no$ &ut try to +tay out o co&alt rooU

D. RADIOSENSITIVITY

MO=( L@== L@A=(

Lens 6can o'aci+!to +orm cataracts

=inalcord

=>in )ery+lo.ly

di)iding3/varies =olid

organ+

6one+

(estis 6)etter

chance o+ not

getting sterile

Ly"

node+

u+cle+

?In eale+ all egg+ are re+ent at &irt"$ ."ile ale+

undergo cycle+7

,. "I#A( 'RD

•

Al.ay+ ree&er ALARA: JAs LoB AsReasona)l! Achieva)le

• Radiology i+ al.ay+ a&out @R=@C(I@: E"atyou +ee i+ not al.ay+ "o. it aear to &e

• Learn to +ee 2D t"ing+ in a HD con+truction inyour .orld+

END OF TRANSCRIPTION

radio 250 e1 lec 01 intro to radiology and radioprotection

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